Adaptive interventions for alcohol misuse and violent behaviors among adolescents and emerging adults in the emergency department: Outcomes from a sequential multiple assignment randomized controlled trial

Introduction: Harnessing technology for delivery of behavioral health interventions to reduce alcohol use and aggression may reduce morbidity among youth. This paper describes the outcomes from a sequential, multiple assignment, randomized trial (SMART) testing interventions for youth (ages 14-20) in the emergency department (ED). Methods: Youth (n = 400) in the ED screening positive for binge drinking and aggression received the SafERteens brief intervention (BI) and were randomly assigned to boosters: Text Messages (TM) or Health Coach (HC) (1st stage; weeks 1-4). Participants completed 8 weekly surveys, with outcomes assessed at 4- and 8-months. After the 1st stage, response/non-response was determined (e.g., binge drinking or aggression). Responders were re- randomized to continued or minimized condition; non-responders were re-randomized to continued or intensified condition (2nd stage; weeks 5-8). Analyses examined outcomes from the initial randomization; and comparisons between responders and non-responders on primary (alcohol consumption, aggression), secondary (alcohol consequences, violence consequences) and exploratory (alcohol misuse, victimization, drug use, drug consequences) outcomes. Results: There were no significant differences in outcomes between 1st stage boosters or 2nd stage boosters for non-responder or responder groups. However, significant changes over time were observed across all participants, with the odds of abstaining from alcohol increased at 4 (OR 3.97, 95 % CI 2.46-6.41) and 8-months (OR 4.36, 95% CI 2.11-9.02), while the odds of aggression (OR 0.39, 95% CI 0.16-0.94) decreased at 8-months; significant decreases were also observed for other outcomes. Conclusions: Findings support the promise of digital health interventions for youth with binge drinking and aggression.