Using Cell Phone Text Messaging to Screen for Hazardous Alcohol Use among Adolescents in a Clinical Setting: A Feasibility Study
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Abstract
Background: Underage alcohol use is the single leading cause of preventable mortality among adolescents in the United States. Furthermore, underage drinking is responsible for more adolescent morbidity than all other drugs combined. Such an important public health problem can be addressed by primary care providers during adolescents’ annual medical checkups.
Objective: This study examines the feasibility, strengths, barriers, and limitations of using cell phone-based text messaging survey (TMS) technology to assess adolescent alcohol use in a clinical setting. We also report on the prevalence of hazardous drinking in this clinical sample and the proportion of clinicians that assessed and advised adolescent patients on the hazards of underage drinking.
Methods: This is a cross-sectional study of 29 consecutive adolescents 13-17 years old attending a pediatric and a family medicine clinic for a clinical evaluation that were approached and asked to participate. Adolescents completed a 16 question TMS while waiting to be seen by their primary care physician (PCP). The TMS included questions about demographic, smoking, alcohol, diet and physical activity behaviors. The CRAFFT instrument was included in the TMS to determine hazardous drinking behavior in this population and setting. CRAFFT is a mnemonic based on key words within the individual questions: “Have you ever ridden in a CAR driven by someone (including yourself) who had been using alcohol?†“Do you ever use alcohol to RELAX, feel better about yourself, or fit in?†“Do you ever use alcohol while you are by yourself or ALONE?†“Do you ever FORGET things that you did while using alcohol?†“Do your family or FRIENDS ever tell you that you should cut down on your drinking?†“Have you ever gotten into TROUBLE while you were using alcohol?†After the clinical evaluation, adolescents completed an additional two-question exit TMS about their PCP’s assessment of, and advising on, underage drinking.
Results: A participation rate of 87% was obtained. The average time to complete the TMS was 15 minutes. Out of 25 adolescents with complete data on the CRAFFT, 8% (n=2) scored a two and therefore met the criteria for hazardous drinking; another 28% (n=7) scored one. The exit TMS found that 38% (6/16) of PCPs asked adolescents about alcohol use and 25% (4/16) offered advice about the health hazards of underage drinking. Neither of the two adolescents who met criteria for hazardous drinking based on the CRAFFT were asked or advised about alcohol use by their PCPs.
Conclusions: Using cell phone text messaging to assess adolescent alcohol use prior to a clinical consultation is feasible, does not seem to disrupt patient workflow in a clinical setting, and has the potential to assess risky health behaviors among adolescents. Text messaging is trusted by adolescents, overcomes many of the limitations of other technologies, and adolescents feel comfortable answering sensitive questions. This is an inexpensive technology that is easy to use and implement; it can influence clinical practice by helping PCPs focus on specific risky health behaviors and areas of concern identified prior to a clinical appointment.
Objective: This study examines the feasibility, strengths, barriers, and limitations of using cell phone-based text messaging survey (TMS) technology to assess adolescent alcohol use in a clinical setting. We also report on the prevalence of hazardous drinking in this clinical sample and the proportion of clinicians that assessed and advised adolescent patients on the hazards of underage drinking.
Methods: This is a cross-sectional study of 29 consecutive adolescents 13-17 years old attending a pediatric and a family medicine clinic for a clinical evaluation that were approached and asked to participate. Adolescents completed a 16 question TMS while waiting to be seen by their primary care physician (PCP). The TMS included questions about demographic, smoking, alcohol, diet and physical activity behaviors. The CRAFFT instrument was included in the TMS to determine hazardous drinking behavior in this population and setting. CRAFFT is a mnemonic based on key words within the individual questions: “Have you ever ridden in a CAR driven by someone (including yourself) who had been using alcohol?†“Do you ever use alcohol to RELAX, feel better about yourself, or fit in?†“Do you ever use alcohol while you are by yourself or ALONE?†“Do you ever FORGET things that you did while using alcohol?†“Do your family or FRIENDS ever tell you that you should cut down on your drinking?†“Have you ever gotten into TROUBLE while you were using alcohol?†After the clinical evaluation, adolescents completed an additional two-question exit TMS about their PCP’s assessment of, and advising on, underage drinking.
Results: A participation rate of 87% was obtained. The average time to complete the TMS was 15 minutes. Out of 25 adolescents with complete data on the CRAFFT, 8% (n=2) scored a two and therefore met the criteria for hazardous drinking; another 28% (n=7) scored one. The exit TMS found that 38% (6/16) of PCPs asked adolescents about alcohol use and 25% (4/16) offered advice about the health hazards of underage drinking. Neither of the two adolescents who met criteria for hazardous drinking based on the CRAFFT were asked or advised about alcohol use by their PCPs.
Conclusions: Using cell phone text messaging to assess adolescent alcohol use prior to a clinical consultation is feasible, does not seem to disrupt patient workflow in a clinical setting, and has the potential to assess risky health behaviors among adolescents. Text messaging is trusted by adolescents, overcomes many of the limitations of other technologies, and adolescents feel comfortable answering sensitive questions. This is an inexpensive technology that is easy to use and implement; it can influence clinical practice by helping PCPs focus on specific risky health behaviors and areas of concern identified prior to a clinical appointment.
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