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Åsberg, K., Eldh, A. C., Löf, M. & Bendtsen, M. (2022). A balancing act–finding one´s way to health and well-being: A qualitative analysis of interviews with Swedish university students on lifestyle and behavior change. PLOS ONE, 17(10), Article ID e0275848.
Open this publication in new window or tab >>A balancing act–finding one´s way to health and well-being: A qualitative analysis of interviews with Swedish university students on lifestyle and behavior change
2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 10, article id e0275848Article in journal (Refereed) Published
Abstract [en]

Introduction Unhealthy lifestyle behaviors such as unhealthy diets, low physical activity levels, smoking, and harmful alcohol consumption are common in student populations, which constitute a large group of young adults. As unhealthy lifestyle behaviors are associated with future disease and premature mortality, most commonly from cardiovascular disease and cancers, it is from a public health perspective important to understand such behaviors in young adult populations. The objective of this study was to investigate university students experiences of health, health-related behaviors, and the barriers and facilitators for behavior change in terms of health promotion in everyday life. Materials and methods This qualitative study was conducted at a middle-sized university in Sweden. Students represented different faculties and were recruited via non-probability convenience sampling using means such as the snowball technique and social media. The 21 interviews with 24 students, individually or in groups, were transcribed verbatim prior to a qualitative analysis inspired by phenomenological hermeneutics. Results Our interviews showed that university student life is associated with new health-related challenges, for example study-related stress and procrastination implies a lack of energy to engage in healthy routines such as physical activity, and a limited budget affects food choices. While adapting to a new context, students explore personal strategies such as taking on changes in manageable steps, seeking social support, and avoiding disturbances to maintaining health and quality of life. Conclusions Experiences of health while becoming and being a university student can be described as a transition-a balancing act of walking a slack line-during which students seek to manage a healthy balance. In the past, interventions have to some extent been designed to address university students behaviors; however, our study aids an understanding of their needs. Future interventions should highlight the transitions they are experiencing and the challenges of student life.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2022
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-191920 (URN)10.1371/journal.pone.0275848 (DOI)000924819300066 ()36227904 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, Grant number 2018-01410
Note

Funding: Swedish Research Council for Health, Working Life, and Welfare [2018-01410]

Available from: 2023-02-23 Created: 2023-02-23 Last updated: 2023-03-24Bibliographically approved
Bendtsen, M. (2022). Avoiding Under- and Overrecruitment in Behavioral Intervention Trials Using Bayesian Sequential Designs: Tutorial. Journal of Medical Internet Research, 24(12), Article ID e40730.
Open this publication in new window or tab >>Avoiding Under- and Overrecruitment in Behavioral Intervention Trials Using Bayesian Sequential Designs: Tutorial
2022 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 24, no 12, article id e40730Article in journal (Refereed) Published
Abstract [en]

Reducing research waste and protecting research participants from unnecessary harm should be top priorities for researchers studying interventions. However, the traditional use of fixed sample sizes exposes trials to risks of under- and overrecruitment by requiring that effect sizes be determined a priori. One mitigating approach is to adopt a Bayesian sequential design, which enables evaluation of the available evidence continuously over the trial period to decide when to stop recruitment. Target criteria are defined, which encode researchers’ intentions for what is considered findings of interest, and the trial is stopped once the scientific question is sufficiently addressed. In this tutorial, we revisit a trial of a digital alcohol intervention that used a fixed sample size of 2129 participants. We show that had a Bayesian sequential design been used, the trial could have ended after collecting data from approximately 300 participants. This would have meant exposing far fewer individuals to trial procedures, including being allocated to the waiting list control condition, and the evidence from the trial could have been made public sooner.

Place, publisher, year, edition, pages
Toronto, ON, Canada: JMIR Publications, Inc., 2022
Keywords
Bayesian sequential design; behavioural intervention; digital alcohol intervention; effect size; participant recruitment; randomized controlled trial; research methods; research participants; sample size; trial procedure; trial recruitment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-191921 (URN)10.2196/40730 (DOI)000965402800001 ()36525297 (PubMedID)2-s2.0-85144588521 (Scopus ID)
Note

Funding: Alcohol Research Council of the Swedish Alcohol Retailing Monopoly [DNR 2019-0056, DNR 2020-0043]

Available from: 2023-02-23 Created: 2023-02-23 Last updated: 2024-01-17Bibliographically approved
Anne, B., Bendtsen, M., Molander, O., Lindfors, P., Lindner, P., Granlund, L., . . . Andersson, C. (2022). Compliance with recommendations limiting COVID-19 contagion among university students in Sweden: associations with self-reported symptoms, mental health and academic self-efficacy. Scandinavian Journal of Public Health, 50(1), 70-84
Open this publication in new window or tab >>Compliance with recommendations limiting COVID-19 contagion among university students in Sweden: associations with self-reported symptoms, mental health and academic self-efficacy
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2022 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 1, p. 70-84Article in journal (Refereed) Published
Abstract [en]

Aims: The COVID-19 containment strategy in Sweden uses public health recommendations relying on personal responsibilityfor compliance. Universities were one of few public institutions subject to strict closure, meaning that students had toadapt overnight to online teaching. This study investigates the prevalence of self-reported recommendation compliance andassociations with self-reported symptoms of contagion, self-experienced effects on mental health and academic self-efficacyamong university students in Sweden in May–June 2020. Methods: This was a cross-sectional 23 question online survey inwhich data were analysed by multinomial regression, taking a Bayesian analysis approach complemented by null hypothesistesting. Results: A total of 4495 students consented to respond. Recommendation compliance ranged between 70% and 96%.Women and older students reported higher compliance than did men and younger students. Mild to moderate COVID-19symptoms were reported by 30%, severe symptoms by fewer than 2%; 15% reported being uncertain and half of theparticipants reported no symptoms. Mental health effects were reported by over 80%, and changes in academic self-efficacywere reported by over 85%; in both these areas negative effects predominated. Self-reported symptoms and uncertaintyabout contagion were associated with non-compliance, negative mental health effects, and impaired academic self-efficacy.Conclusions: Students generally followed public health recommendations during strict closure of universities,but many reported considerable negative consequences related to mental health and academic self-efficacy.Digital interventions should be developed and evaluated to boost coping skills, build resilience and alleviatestudent suffering during the pandemic and future similar crises.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
COVID-19, pandemics, epidemiology, social medicine, higher education, students, recommendation compliance, mental health, academic self-efficacy, digital interventions
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-178079 (URN)10.1177/14034948211027824 (DOI)000672123200001 ()34213359 (PubMedID)2-s2.0-85109195249 (Scopus ID)
Note

Funding: Swedish Research CouncilSwedish Research CouncilEuropean Commission [2019-01127]

Available from: 2021-07-27 Created: 2021-07-27 Last updated: 2022-05-19Bibliographically approved
Bendtsen, M. & McCambridge, J. (2021). Causal models accounted for research participation effects when estimating effects in a behavioral intervention trial. Journal of Clinical Epidemiology, 136, 77-83
Open this publication in new window or tab >>Causal models accounted for research participation effects when estimating effects in a behavioral intervention trial
2021 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 136, p. 77-83Article in journal (Refereed) Published
Abstract [en]

Objective Participants in intervention studies are asked to take part in activities linked to the conduct of research, including signing consent forms and being assessed. If participants are affected by such activities through mechanisms by which the intervention is intended to work, then there is confounding. We examine how to account for research participation effects analytically.

Study design and setting Data from a trial of a brief alcohol intervention among Swedish university students is used to show how a proposed causal model can account for assessment effects.

Results The proposed model can account for research participation effects as long as researchers are willing to use existing data to make assumptions about causal influences, for instance on the magnitude of assessment effects. The model can incorporate several research processes which may introduce bias.

Conclusions As our knowledge grows about research participation effects, we may move away from asking if participants are affected by study design, toward rather asking by how much they are affected, by which activities and in which circumstances. The analytic perspective adopted here avoids assuming there are no research participation effects.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Research participation effects, Behavioral interventions, Randomized controlled trials, Causal models, Bias Statistical analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-178077 (URN)10.1016/j.jclinepi.2021.03.008 (DOI)000694917100010 ()33727133 (PubMedID)2-s2.0-85103794777 (Scopus ID)
Note

Funding: Swedish Council For Working Life and Social Research (FAS)Swedish Research CouncilSwedish Research Council for Health Working Life & Welfare (Forte) [2010-0024]

Available from: 2021-07-27 Created: 2021-07-27 Last updated: 2022-01-14Bibliographically approved
Bendtsen, M. & Thomas, K. (2021). Mental health promotion among university students using a mobile health intervention: longitudinal findings from a randomized controlled trial. European Journal of Applied Positive Psychology, 5, Article ID 12.
Open this publication in new window or tab >>Mental health promotion among university students using a mobile health intervention: longitudinal findings from a randomized controlled trial
2021 (English)In: European Journal of Applied Positive Psychology, ISSN 2397-7116, Vol. 5, article id 12Article in journal (Refereed) Published
Abstract [en]

Background: Research shows that positive psychology interventions have a small to medium effect on wellbeing, depression, anxiety, and stress. However, few studies have investigated long-term mental health outcomes.

Methods: This paper reports on the 6- and 12-month effects of a mobile phone based positive psychology intervention on wellbeing among university students in Sweden. A 2-arm, single blind (researchers), parallel groups, randomized controlled trial was employed.

Results: In total 654 individuals (25 years median age, 78% female) were randomized to the intervention (n=348) or control group (n=306). Primary outcome was positive mental health (Mental Health Continuum-Short Form).  Secondary outcomes were depression and anxiety symptomatology (Hospital Anxiety and Depression Scale). A lasting effect on wellbeing was observed. An immediate positive effect was observed on anxiety and depression outcomes which waned over time.

Discussion and conclusions: The findings suggest that mobile phone-based interventions could be an important tool in a wider strategy for mental health promotion. Future research could improve on the effects observed in this study by finding ways to optimise person-activity fit and tailor the intervention content.

Place, publisher, year, edition, pages
National Wellbeing Service, 2021
Keywords
mental health promotion; positive psychology intervention; mobile health intervention; university students; randomized controlled trial
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-183727 (URN)
Available from: 2022-03-20 Created: 2022-03-20 Last updated: 2022-05-19Bibliographically approved
Bendtsen, M., Seiterö, A., Bendtsen, P., Olsson, H., Henriksson, P., Thomas, K., . . . Müssener, U. (2021). mHealth intervention for multiple lifestyle behaviour change among high school students in Sweden (LIFE4YOUth): Protocol for a randomised controlled trial. Public Health Nursing, 21(1)
Open this publication in new window or tab >>mHealth intervention for multiple lifestyle behaviour change among high school students in Sweden (LIFE4YOUth): Protocol for a randomised controlled trial
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2021 (English)In: Public Health Nursing, ISSN 0737-1209, E-ISSN 1525-1446, Vol. 21, no 1Article in journal (Refereed) Published
Abstract [en]

BackgroundNational surveys in Sweden demonstrate that the majority of young people do not engage in health promoting behaviours at levels recommended by the Public Health Agency of Sweden. The objective of this study is to estimate the effectiveness of a novel mHealth intervention named LIFE4YOUth, which targets multiple lifestyle behaviours (alcohol, diet, physical activity, and smoking) among high school students in Sweden.MethodsA 2-arm parallel groups single blind randomised controlled trial (1:1) will be employed to estimate the effectiveness of the novel mHealth intervention. Students will be recruited at high schools throughout Sweden, and will be included if they fulfil one of six criteria relating to unhealthy behaviours with respect to alcohol, diet, physical activity and smoking. Eligible participants will be randomised to either receive the novel intervention immediately, or to be placed on a waiting list for 4 months. The intervention consists of a combination of recurring screening, text messages, and an interactive platform which is adaptable to individual preferences. Outcome measures with respect to alcohol, diet, physical activity and smoking will be assessed through questionnaires at 2 and 4 months post randomisation.DiscussionThe findings of this trial could be generalised to a diverse high-school student population as our recruitment encompass a large proportion of schools throughout Sweden with various educational profiles. Furthermore, if effective, the mHealth intervention has good potential to be able to be scaled up and disseminated at high schools nationally.Trial registrationRegistered prospectively on 2020-05-20 in ISRCTN (ISRCTN34468623).

Place, publisher, year, edition, pages
BMC, 2021
Keywords
Telemedicine; Multiple behaviour; mHealth; High school students; Randomised controlled trial
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-178080 (URN)10.1186/s12889-021-11446-9 (DOI)000675238000003 ()34271882 (PubMedID)
Note

Funding: Swedish Research Council for Health, Working Life and WelfareSwedish Research CouncilSwedish Research Council for Health Working Life & Welfare (Forte) [2018-01410]; Linkoping University

Available from: 2021-07-27 Created: 2021-07-27 Last updated: 2021-08-27
Åsberg, K. & Bendtsen, M. (2021). Perioperative digital behaviour change interventions for reducing alcohol consumption, improving dietary intake, increasing physical activity and smoking cessation: a scoping review. Perioperative Medicine, 10, Article ID 18.
Open this publication in new window or tab >>Perioperative digital behaviour change interventions for reducing alcohol consumption, improving dietary intake, increasing physical activity and smoking cessation: a scoping review
2021 (English)In: Perioperative Medicine, E-ISSN 2047-0525, Vol. 10, article id 18Article, review/survey (Refereed) Published
Abstract [en]

Background: Evidence suggests that unhealthy lifestyle behaviours are modifiable risk factors for postoperativecomplications. Digital behaviour change interventions (DBCIs), for instance text messaging programs and smartphoneapps, have shown promise in achieving lifestyle behaviour change in a wide range of clinical populations, and it maytherefore be possible to reduce postoperative complications by supporting behaviour change perioperatively usingdigital interventions. This scoping review was conducted in order to identify existing research done in the area ofperioperative DBCIs for reducing alcohol consumption, improving dietary intake, increasing physical activity andsmoking cessation.Main text: This scoping review included eleven studies covering a range of surgeries: bariatric, orthopaedic, cancer,transplantation and elective surgery. The studies were both randomised controlled trials and feasibility studies andinvestigated a diverse set of interventions: one game, three smartphone apps, one web-based program and five textmessage interventions. Feasibility studies reported user acceptability and satisfaction with the behaviour changesupport. Engagement data showed participation rates ranged from 40 to 90%, with more participants being activelyengaged early in the intervention period. In conclusion, the only full-scale randomised controlled trial (RCT), textmessaging ahead of bariatric surgery did not reveal any benefits with respect to adherence to preoperative exerciseadvice when compared to a control group. Two of the pilot studies, one text message intervention, one game,indicated change in a positive direction with respect to alcohol and tobacco outcomes, but between groupcomparisons were not done due to small sample sizes. The third pilot-study, a smartphone app, found between groupchanges for physical activity and alcohol, but not with respect to smoking cessation outcomes.

Conclusion: This review found high participant satisfaction, but shows recruitment and timing-delivery issues, as wellas low retention to interventions post-surgery. Small sample sizes and the use of a variety of feasibility outcomemeasures prevent the synthesis of results and makes generalisation difficult. Future research should focus on definingstandardised outcome measures, enhancing patient engagement and improving adherence to behaviour change priorto scheduled surgery.

Place, publisher, year, edition, pages
BMC, 2021
Keywords
Perioperative, Digital behaviour change inter, Lifestyle behaviour, Feasibility, Randomised controlled trial, Scoping review
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-178078 (URN)10.1186/s13741-021-00189-1 (DOI)000669870800001 ()34225795 (PubMedID)
Note

Funding: Region Ostergotland (Strategiomradet Sjukvard och Valfard) [LIO-858631]; Swedish Research Council for Health, Working Life and Welfare (FORTE) [2018-01410]; Swedish Cancer Society (Cancerfonden)Swedish Cancer Society [20 0883]; Linkoping University

Available from: 2021-07-27 Created: 2021-07-27 Last updated: 2022-05-26Bibliographically approved
Bendtsen, M., Müssener, U., Linderoth, C. & Thomas, K. (2020). A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial. JMIR mhealth and uhealth, 8(3), Article ID e17208.
Open this publication in new window or tab >>A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial
2020 (English)In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 8, no 3, article id e17208Article in journal (Refereed) Published
Abstract [en]

Background: High positive mental health, including the ability to cope with the normal stresses of life, work productively, and be able to contribute to one’s community, has been associated with various health outcomes. The role of positive mental health is therefore increasingly recognized in national mental health promotion programs and policies. Mobile health (mHealth) interventions could be a cost-effective way to disseminate positive psychological interventions to the general population.

Objective: The aim of this study was to estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomology among Swedish university students using a randomized controlled trial design.

Methods: A 2-arm, single-blind (researchers), parallel-groups randomized controlled trial with an mHealth positive psychology program intervention group and a relevant online mental health information control group was employed to estimate the effect of the novel intervention. Participants were recruited using digital advertising through student health care centers in Sweden. Inclusion criteria were (1) university students, (2) able to read and understand Swedish, (3) and have access to a mobile phone. Exclusion criteria were high positive mental health, as assessed by the Mental Health Continuum Short Form (MHC-SF), or high depression and anxiety symptomology, as assessed by the Hospital Anxiety Depression Scale (HADS). The primary outcome was positive mental health (MHC-SF), and the secondary outcomes were depression and anxiety symptomatology (HADS). The subscales of MHC-SF were also analyzed as exploratory outcomes. Outcomes were measured 3 months after randomization through questionnaires completed on the participants’ mobile phones.

Results: A total of 654 participants (median age 25 years), including 510 (78.0%) identifying as female, were randomized to either the intervention (n=348) or control group (n=306). At follow-up, positive mental health was significantly higher in the intervention group compared with the control group (incidence rate ratio [IRR]=1.067, 95% CI 1.024-1.112, P=.002). For both depression and anxiety symptomatology, the intervention group showed significantly lower scores at follow-up compared with the control group (depression: IRR=0.820, 95% CI 0.714-0.942, P=.005; anxiety: IRR=0.899, 95% CI 0.840-0.962, P=.002). Follow-up rates were lower than expected (58.3% for primary outcomes and 52.3% for secondary outcomes); however, attrition analyses did not identify any systematic attrition with respect to baseline variables.

Conclusions: The mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students. A protective effect of the intervention was also found on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to enhance positive mental health, which offers promise for the use of mHealth solutions in public mental health promotion.

Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN54748632; http://www.isrctn.com/ISRCTN54748632

Place, publisher, year, edition, pages
Toronto, ON, Canada: J M I R Publications, Inc., 2020
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-164919 (URN)10.2196/17208 (DOI)000521195300001 ()32196462 (PubMedID)2-s2.0-85082112688 (Scopus ID)
Available from: 2020-04-01 Created: 2020-04-01 Last updated: 2020-04-23Bibliographically approved
Ek, A., Alexandrou, C., Söderström, E., Bergman, P., Nystrom, C. D., Direito, A., . . . Löf, M. (2020). Effectiveness of a 3-Month Mobile Phone-Based Behavior Change Program on Active Transportation and Physical Activity in Adults: Randomized Controlled Trial. JMIR mhealth and uhealth, 8(6), Article ID e18531.
Open this publication in new window or tab >>Effectiveness of a 3-Month Mobile Phone-Based Behavior Change Program on Active Transportation and Physical Activity in Adults: Randomized Controlled Trial
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2020 (English)In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 8, no 6, article id e18531Article in journal (Refereed) Published
Abstract [en]

yyy Background: Active transportation (AT; ie, walking and cycling as a mode for transportation) has been associated with decreased morbidity and mortality; however, low-cost and scalable intervention programs are lacking. Objective: The goal of the research was to determine the effectiveness of a 3-month behavior change program delivered via a mobile phone app to promote AT (TravelVu Plus) on time spent in moderate-to-vigorous physical activity (MVPA). Methods: For this 2-arm parallel randomized controlled trial, we recruited a population-based sample of 254 adults from Stockholm County who were aged 20 to 65 years and had access to a smartphone. On completion of 1-week baseline measures, the 254 participants were randomized to either the control or intervention group (1:1 ratio). Both groups had access to the standard TravelVu app (Trivector AB) for monitoring their AT for 6 months. The intervention group also received a 3-month behavior change program to promote AT (TravelVu Plus app). Assessors of outcomes were blinded to group allocation. Outcomes were objectively measured MVPA at 3 (primary) and 6 months. Secondary outcomes were AT, attitudes toward AT, and health-related quality of life at 3 and 6 months. Results: No effect on MVPA was observed after 3 months (P=.29); however, at 6 months the intervention group had a greater improvement in MVPA than the controls (6.05 minutes per day [95% CI 0.36 to 11.74; P=.04]). A Bayesian analyses showed that there was a 98% probability that the intervention had any effect at 6 months, and a 63% probability that this effect was >5 minute MVPA per day. Conclusions: No effect on MVPA immediately after the intervention period (at 3 months) was observed; however, there was a delayed effect on MVPA (6 minutes per day) at 6 months, which corresponds to approximately 30% of the weekly MVPA recommendation. Our findings suggest that a behavior change program promoting AT delivered via an app may have a relevant effect on PA.

Place, publisher, year, edition, pages
JMIR PUBLICATIONS, INC, 2020
Keywords
behavior change; mobile phone intervention; physical activity; active transportation; mobile phone app; smartphone app
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-167291 (URN)10.2196/18531 (DOI)000538748500001 ()32510462 (PubMedID)
Note

Funding Agencies|Forte [2016-00138]; Karolinska InstitutetKarolinska Institutet [2018-01730]

Available from: 2020-07-02 Created: 2020-07-02 Last updated: 2021-12-28
Bendtsen, M. (2020). Heterogeneous treatment effects of a text messaging smoking cessation intervention among university students. PLOS ONE, 15(3), Article ID e0229637.
Open this publication in new window or tab >>Heterogeneous treatment effects of a text messaging smoking cessation intervention among university students
2020 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 3, article id e0229637Article in journal (Refereed) Published
Abstract [en]

Introduction

Despite tobacco being an important preventable factor with respect to ill health and death, it is a legal substance that harms and kills many of those who use it. Text messaging smoking cessation interventions have been evaluated in a variety of contexts, and are generally considered to have a positive effect on smoking cessation success. In order for text messaging interventions to continue to be useful as prevalence of smoking decreases, it may be necessary to tailor the interventions to specific individuals. However, little is known with regard to who benefits the most and least from existing interventions.

Methods

In order to identify heterogenous treatment effects, we analyzed data from a randomized controlled trial of a text messaging smoking cessation intervention targeting university students in Sweden. We used a Bayesian hierarchical model where the outcome was modelled using logistic regression, and so-called horseshoe priors were used for coefficients. Predictive performance of the model, and heterogeneous treatment effects, were calculated using cross-validation over the trial data.

Results

Findings from the study of heterogenous treatment effects identified less effect of the intervention among university students with stronger dependence of nicotine and students who smoke a greater quantity of cigarettes per week. No heterogeneity was found with respect to sex, number of years smoking, or the use of snuff.

Discussion

Results emphasize that individuals with a more developed dependence of nicotine may have a harder time quitting smoking even with support. This questions the dissemination and development of text messaging interventions to university students in the future, as they may not be the optimal choice of intervention for those with a more developed dependence. On the other hand, text messaging interventions may be useful to disseminate among university students that are at risk of developing a strong dependence.

Trial registration

International Standard Randomized Controlled Trial Number (ISRCTN): 75766527; http://www.controlled-trials.com/ISRCTN75766527.

Place, publisher, year, edition, pages
San Francisco, CA, United States: Public Library of Science, 2020
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-164917 (URN)10.1371/journal.pone.0229637 (DOI)000535265600035 ()32134977 (PubMedID)2-s2.0-85081007357 (Scopus ID)
Note

Funding agencies: Swedish Research Council for Health, Working Life and Welfare (FORTE) [Dnr: 2018-01410]

Available from: 2020-04-01 Created: 2020-04-01 Last updated: 2021-06-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8678-1164

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