@Article{info:doi/10.2196/60332, author="Egan, L. Kathleen and Cox, J. Melissa and Helme, W. Donald and Jackson, Todd J. and Richman, R. Alice", title="Text Message Intervention to Facilitate Secure Storage and Disposal of Prescription Opioids to Prevent Diversion and Misuse: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Apr", day="17", volume="14", pages="e60332", keywords="prescription opioid", keywords="storage", keywords="disposal", keywords="text message intervention", keywords="randomized controlled trial", keywords="mobile phone", abstract="Background: Nonmedical use of prescription opioids remains a critical public health issue; 8.5 million people in the United States misused opioids in 2022. Most people obtain prescription opioids for misuse from family or friends. Thus, facilitating secure storage and disposal of opioid medications during and after treatment is needed to prevent medication diversion and subsequent misuse. Objective: The primary objective of this study is to test the feasibility and efficacy of a novel intervention that uses a persuasive, informational SMS text message reminder system to enhance the impact of secure storage and disposal of unused opioid medications. We hypothesize that the SMS text message intervention will increase secure storage during treatment and disposal of prescription opioids after treatment. Methods: We will use a 2-arm randomized controlled trial to test the intervention for feasibility and efficacy. Participants (aged 18+ years who have received an opioid prescription in the past 2 weeks) will be randomly assigned to either receive the SMS text message intervention or standard-of-care educational materials. Participants in the intervention will receive 4 SMS text messages related to secure storage and 3 messages related to disposal. All participants will complete baseline, midpoint (day 25), and postintervention (day 45) evaluation surveys. We will test whether receipt of the intervention is associated with two primary outcomes, which are (1) secure storage of prescription opioid medication (locked vs unlocked) and (2) disposal of unused prescription opioid medication (disposed vs not disposed). We will use multiple logistic regression to test the main hypotheses that the intervention will be positively associated with secure storage (locked vs unlocked) and disposal (yes vs no) behaviors, which will allow us to control for demographic variables known to influence the outcomes. This protocol represents the entire structure of the randomized controlled trial. Results: Recruitment for the randomized controlled trial was launched in April 2024, and data collection was completed in December 2024. The final sample size is 484. Data analyses for the main hypothesis will be completed by May 2025, and the main hypothesis manuscript will be submitted for publication by May 2025. Conclusions: Results from this study will indicate whether a text message reminder system can increase secure storage and disposal behaviors for individuals who receive opioid medication. This type of intervention has the potential to be integrated into currently used health care delivery systems, such as prescription pickup reminders at pharmacies. Thus, the intervention is scalable across systems of care, thus expanding the reach of secure storage and disposal programs to prevent prescription opioid misuse. Trial Registration: ClinicalTrials.gov NCT05503186; https://clinicaltrials.gov/study/NCT05503186 International Registered Report Identifier (IRRID): DERR1-10.2196/60332 ", doi="10.2196/60332", url="https://www.researchprotocols.org/2025/1/e60332" } @Article{info:doi/10.2196/55621, author="Chernick, Rachel and Sy, Amanda and Dauber, Sarah and Vuolo, Lindsey and Allen, Bennett and Muench, Fred", title="Demographics and Use of an Addiction Helpline for Concerned Significant Others: Observational Study", journal="J Med Internet Res", year="2025", month="Apr", day="14", volume="27", pages="e55621", keywords="family", keywords="hotline", keywords="helpline", keywords="warmline", keywords="crisis continuum", keywords="substance abuse", keywords="addiction", keywords="youth", keywords="concerned significant other", keywords="digital behavioral health", keywords="parents", keywords="substance use disorders", keywords="well-being", keywords="public health intervention", keywords="cannabis", keywords="treatment", keywords="opioids", keywords="men", keywords="women", keywords="assessments", abstract="Background: Concerned significant others (CSOs) play a significant role in supporting individuals with substance use disorders. There is a lack of tailored support services for these CSOs, despite their substantial contributions to the well-being of their loved ones (LOs). The emergence of helplines as a potential avenue for CSO support is outlined, culminating in the focus on the Partnership to End Addiction's helpline service, an innovative public health intervention aimed at aiding CSOs concerned about an LO's substance use. Objective: The article analyzes the demographics and use patterns of the Partnership to End Addiction's helpline service, highlighting the critical role of such services, and advocating for expanded, tailored support models. Methods: This observational study draws data from 8 data platforms spanning April 2011 to December 2021, encompassing 24,096 client records. Surveys were completed by helpline specialists during synchronous telephone calls or self-reported by CSOs before helpline engagement. Collected information encompasses demographics, interaction language, substance of concern, CSO-LO relationship, and the LO's ``use state,'' that is, their location on the continuum of substance use. Results: CSOs primarily comprised women (13,980/18,373, 76.1\%) seeking support for their children (1062/1542, 68.9\%). LOs were mostly male (1090/1738, 62.7\%), aged 18-25 years (2380/7208, 33\%), with primary substance concerns being cannabis (5266/12,817, 40.9\%), opioids (2445/12,817, 19\%), and stimulants (1563/12,817, 12.1\%). CSOs primarily sought aid for LOs struggling with substances who were not in treatment (1102/1753, 62.9\%). The majority of CSOs were looking for support in English (14,738/17,920, 82.2\%), while the rest (3182/17,920, 17.8\%) preferred to communicate in Spanish. Spanish-speaking CSOs were significantly more likely to call about cannabis (n=963, 53.7\% vs n=4026, 38.6\%) and stimulants (n=304, 16.9\% vs n=1185, 11.3\%) than English-speaking CSOs (P<.001). On the other hand, English-speaking CSOs were more likely to be concerned about opioids than Spanish-speaking CSOs (n=2215, 21.3\% vs n=94, 5.2\%; P<.001). Conclusions: The study illuminates the helpline's pioneering role in aiding CSOs grappling with an LO's substance use. It highlights helplines as crucial resources for CSOs, revealing key demographic, substance-related, and use-state trends. The dominant presence of women among users aligns with other helpline patterns and reflects traditional caregiving roles. While parents form a significant percentage of those reaching out, support is also sought by siblings, friends, and other family members, emphasizing the need for assistance for other members of an LO's social network. Spanish-speaking individuals' significant outreach underscores the necessity for bilingual support services. Substance concerns revolve around cannabis, opioids, and stimulants, influenced by age and language preferences. The helpline serves as an essential intermediary for CSOs, filling a gap between acute crisis intervention services and formalized health care and treatment services. Overall, the study highlights this helpline's crucial role in aiding CSOs with tailored, accessible support services. ", doi="10.2196/55621", url="https://www.jmir.org/2025/1/e55621" } @Article{info:doi/10.2196/54753, author="Filiatreau, M. Lindsey and Szlyk, Hannah and Ramsey, T. Alex and Kasson, Erin and Li, Xiao and Zhang, Zhuoran and Cavazos-Rehg, Patricia", title="Sociodemographic Differences in Logins and Engagement With the Electronic Health Coach Messaging Feature of a Mobile App to Support Opioid and Stimulant Use Recovery: Results From a 1-Month Observational Study", journal="JMIR Mhealth Uhealth", year="2025", month="Apr", day="10", volume="13", pages="e54753", keywords="substance misuse", keywords="substance use recovery", keywords="opioid use disorder", keywords="stimulant use disorder", keywords="uptake", keywords="engagement", keywords="mHealth", keywords="digital health intervention", keywords="sociodemographic", keywords="mobile app", keywords="stimulant use", keywords="observational study", keywords="mobile health", keywords="smartphone", keywords="St. Louis", keywords="eCoach messaging", keywords="Wilcoxon rank-sum tests", keywords="Pearson chi-square", keywords="recovery", keywords="app", abstract="Background: Mobile health apps can serve as a critical tool in supporting the overall health of uninsured and underinsured individuals and groups who have been historically marginalized by the medical community and may be hesitant to seek health care. However, data on uptake and engagement with specific app features (eg, in-app messaging) are often lacking, limiting our ability to understand nuanced patterns of app use. Objective: This study aims to characterize sociodemographic differences in uptake and engagement with a smartphone app (uMAT-R) to support recovery efforts in a sample of individuals with opioid and stimulant use disorders in the Greater St. Louis area. Methods: We enrolled individuals into the uMAT-R service program from facilities providing recovery support in the Greater St. Louis area between January 2020 and April 2022. Study participants were recruited from service project enrollees. We describe the number of logins and electronic health coach (eCoach) messages participants sent in the first 30 days following enrollment using medians and IQRs and counts and proportions of those who ever (vs never) logged in and sent their eCoach a message. We compare estimates across sociodemographic subgroups, by insurance status, and for those who did and did not participate in the research component of the project using Wilcoxon rank-sum tests and Pearson chi-square tests. Results: Of all 695 participants, 446 (64.2\%) logged into uMAT-R at least once during the 30 days following enrollment (median 2, IQR 0-8 logins). Approximately half of those who logged in (227/446) used the eCoach messaging feature (median 1, IQR 0-3 messages). Research participants (n=498), who could receive incentives for app engagement, were more likely to log in and use the eCoach messaging feature compared to others (n=197). Younger individuals, those with higher educational attainment, and White, non-Hispanic individuals were more likely to log in at least once compared to their counterparts. The median number of logins was higher among women, and those who were younger, employed, and not on Medicaid compared to their counterparts. Among those who logged in at least once, younger individuals and those with lower educational attainment were more likely to send at least one eCoach message compared to others. Conclusions: Mobile apps are a viable tool for supporting individuals in recovery from opioid and stimulant use disorders. However, older individuals, racial and ethnic minorities, and those with lower educational attainment may need additional login support, or benefit from alternative mechanisms of recovery support. In addition, apps may need to be tailored to achieve sustained engagement (ie, repeat logins) among men, and individuals who are older, unemployed, or on Medicaid. Older individuals and those with higher educational attainment who may be less likely to use eCoach messaging features could benefit from features tailored to their preferences. ", doi="10.2196/54753", url="https://mhealth.jmir.org/2025/1/e54753" } @Article{info:doi/10.2196/49981, author="Rotondo, Jenny and VanSteelandt, Amanda and Kouyoumdjian, Fiona and Bowes, J. Matthew and Kakkar, Tanya and Jones, Graham and Abele, Brandi and Murray, Regan and Schleihauf, Emily and Halverson, Jessica and Leason, Jennifer and Huyer, Dirk and Jackson, Beth and Bozat-Emre, Songul and Shah, Devanshi and Rees, E. Erin", title="Substance-Related Acute Toxicity Deaths in Canada From 2016 to 2017: Protocol for a Retrospective Chart Review Study of Coroner and Medical Examiner Files", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="10", volume="11", pages="e49981", keywords="acute toxicity", keywords="Canada", keywords="chart review study", keywords="coroner", keywords="death investigations", keywords="drug overdose", keywords="medical examiner", keywords="mortality", keywords="poisoning", keywords="protocol", abstract="Background: Canada continues to experience a national overdose crisis. While studies are available at the regional, provincial, and territorial levels, detailed national data regarding the burden and context of substance-related acute toxicity deaths are limited, particularly in subpopulations. In response to the overdose crisis, the Public Health Agency of Canada, in collaboration with provincial and territorial ministries of health and chief coroner and chief medical examiner offices, has undertaken a national chart review study. Objective: This study was conducted to describe and compare the characteristics of substance-related acute toxicity deaths that occurred in Canada between 2016 and 2017, including descriptions of those who died, the substances involved, and the circumstances surrounding their deaths. This paper describes the study methodology in detail. Methods: This retrospective, population-based, and cross-sectional study involved the review of coroner and medical examiner files for deaths that met the study case definition. Data were collected on demographic and socioeconomic characteristics, medical and substance use history, proximal circumstances surrounding the death, and toxicology findings using a standardized data collection tool that underwent 2 pilot studies. Data abstractors underwent training and regular intrarater reliability exercises with a fictitious death investigation file. Data quality was assessed based on the consistency of abstractor intrarater reliability scores and the completeness of core variables and variables for key concepts. Data were linked to national datasets to allow for the examination of area-level geographic and socioeconomic characteristics. Descriptive analyses will examine differences across subpopulations and the general Canadian population. Latent class, spatiotemporal, qualitative, and premature death analyses are also planned. Where possible, analyses will be stratified by the manner of death and sex. Results: The study began in the summer of 2018, and abstraction was delayed due to the COVID-19 pandemic. All activities are expected to be completed by early 2025. A total of 9414 coroner and medical examiner files met the study case definition. Most abstractors (25/26, 96\%) met the established threshold for consistency throughout abstraction without the need for remedial training. In general, core study variables, including geographic variables and substances contributing to death, had very good availability. Study variables related to the person's health, history of substance use, and events surrounding the acute toxicity event were available for most records. Socioeconomic variables and variables describing socially constructed identities and potentially traumatic life events were mostly unavailable. Conclusions: This study provides the most detailed national information on substance-related acute toxicity deaths in Canada to date and can serve as a pre--COVID-19 pandemic baseline for assessing the evolution of the overdose crisis. Results can inform policies and programs to address the overdose crisis, the development of common approaches to medicolegal death investigations, and future research activities. ", doi="10.2196/49981", url="https://publichealth.jmir.org/2025/1/e49981", url="http://www.ncbi.nlm.nih.gov/pubmed/40208661" } @Article{info:doi/10.2196/65847, author="Tam, Chi Cheuk and Young, D. Sean and Harrison, Sayward and Li, Xiaoming and Litwin, H. Alain", title="Theory-Based Social Media Intervention for Nonmedical Use of Prescription Opioids in Young Adults: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="26", volume="14", pages="e65847", keywords="nonmedical use of prescription opioids", keywords="opioid misuse", keywords="young adults", keywords="social media", keywords="psychosocial intervention", keywords="randomized controlled trial", keywords="mixed methods", abstract="Background: The nonmedical use of prescription opioids (NMUPO) in young adults in the United States is concerning and is robustly influenced by many psychosocial factors. Given the advantages of flexibility, wide coverage, and real-time responses and assessment, using social media appears to be a promising and innovative approach to delivering psychosocial intervention to young adults. However, few theory-based social media interventions are available for NMUPO targeting this at-risk population. Objective: Guided by the information-motivation-behavioral skills model, the proposed research aims to address critical gaps by theoretically exploring psychosocial content associated with NMUPO among young adults via formative assessment. These findings will then be used to develop and evaluate the feasibility and preliminary efficacy of a peer-led social media intervention to reduce NMUPO among young adults. Methods: The proposed study will comprise serial research activities. First, formative research will be conducted through semistructured interviews among 30 young adults engaged in NMUPO. Qualitative data will be synthesized using a pragmatic approach for identifying psychosocial content associated with NMUPO. Second, qualitative findings will be used for developing a peer-led social media intervention to reduce NMUPO among young adults by integrating promising psychotherapy principles and incorporating them with well-trained recovery coaches. Third, the social media intervention will be evaluated through a 12-week randomized controlled trial among 70 young adults (n=35, 50\% in the intervention group and control group) engaged in NMUPO via mixed methods, including pre- and postintervention surveys, social media paradata (eg, time-series reactions to posts) collection, and ecological momentary assessment during the intervention. The control group will not receive an intervention but will complete the pre- and postintervention surveys. The primary outcomes will be feasibility, usability, and acceptability, while the secondary outcomes will be psychosocial and behavioral measures, such as past--3-month NMUPO, intention, psychological distress, self-efficacy, resilience, and coping strategies. Results: The proposed study was funded in May 2024. Social media campaigns have received responses from a total of 379 individuals, with 24 (6.3\%) identified as eligible. As of February 10, 2025, we have completed formative interviews with 8 eligible participants. Conclusions: The proposed study will be one of the first efforts to develop and deliver a theory-based peer-led intervention on social media, incorporating empirical findings on the psychosocial mechanism of NMUPO. The findings of the proposed study will provide valuable insights into opioid risk reduction for young adults through an innovative approach. If the tested trial is found to be feasible, the proposed study will contribute to future scaled-up and fully powered psychosocial interventions among young adults and other key populations at risk for NMUPO. Trial Registration: ClincialTrials.gov NCT06469749; https://clinicaltrials.gov/study/NCT06469749 International Registered Report Identifier (IRRID): DERR1-10.2196/65847 ", doi="10.2196/65847", url="https://www.researchprotocols.org/2025/1/e65847" } @Article{info:doi/10.2196/65693, author="Oesterle, S. Tyler and Bormann, L. Nicholas and Paul, M. Margaret and Breitinger, A. Scott and Lai, Benjamin and Smith, L. Jamie and Stoppel, J. Cindy and Arndt, Stephan and Williams, D. Mark", title="Treatment of Substance Use Disorders With a Mobile Phone App Within Rural Collaborative Care Management (Senyo Health): Protocol for a Mixed Methods Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="26", volume="14", pages="e65693", keywords="substance-related disorders", keywords="mobile apps", keywords="primary care", keywords="clinical trial", keywords="substance use disorder", keywords="SUD", keywords="addiction treatment", keywords="telemedicine", keywords="telepsychiatry", keywords="care management", keywords="community-based care", keywords="behavioral health program", abstract="Background: COVID-19 worsened an already existing problem in substance use disorder (SUD) treatment. However, it helped transform the use of telehealth, which particularly benefits rural America. The lack of specialty addiction treatment in rural areas places the onus on primary care providers. Screening, brief intervention, and referral to treatment (SBIRT) is an evidenced-based strategy commonly used in primary care settings to target SUD outcomes and related behaviors. The integration of telehealth tools within the SBIRT pathway may better sustain the program in primary care. Building on Mayo Clinic's experience with collaborative care management (CoCM) for mental health treatment, we built a digitally native, integrated, behavioral health CoCM platform using a novel mobile app and web-based provider platform called Senyo Health. Objective: This protocol describes a novel use of the SBIRT pathway using Senyo Health to complement existing CoCM integration within primary care to deliver SUD treatment to rural patients lacking other access. We hypothesize that this approach will improve SUD-related outcomes within rural primary care clinics. Methods: Senyo Health is a digital tool to facilitate the use of SBIRT in primary care. It contains a web-based platform for clinician and staff use and a patient-facing mobile phone app. The app includes 16 learning modules along with data collection tools and a chat function for communicating directly with a licensed drug counselor. Beta-testing is currently underway to examine opportunities to improve Senyo Health prior to the start of the trial. We describe the development of Senyo Health and its therapeutic content and data collection instruments. We also describe our evaluation strategy including our measurement plan to assess implementation through a process guided by Consolidated Framework for Implementation Research methods and effectiveness through a waitlist control trial. A randomized controlled trial will occur where 30 participants are randomly assigned to immediately start the Senyo intervention compared to a waitlist control group of 30 participants who will start the active intervention after a 12-week delay. Results: The Senyo Health app was launched in May 2023, and the most recent update was in August 2024. Our funding period began in September 2023 and will conclude in July 2027. This protocol defines a novel implementation strategy for leveraging a digitally native, clinical platform that enables the delivery of CoCM to target an SUD-specific patient population. Our trial will begin in June 2025. Conclusions: We present a theory of change and study design to assess the impact of a novel and patient-centered mobile app to support the SBIRT approach to SUD in primary care settings. Trial Registration: ClinicalTrials.gov NCT06743282; http://clinicaltrials.gov/ct2/show/NCT06743282 International Registered Report Identifier (IRRID): PRR1-10.2196/65693 ", doi="10.2196/65693", url="https://www.researchprotocols.org/2025/1/e65693" } @Article{info:doi/10.2196/72032, author="Hooten, Michael W. and Erickson, J. Darin and Chawarski, Marek and Scholz, A. Natalie and Waljee, F. Jennifer and Brummett, M. Chad and Jeffery, M. Molly", title="Unintended Prolonged Opioid Use: Protocol for a Case-Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="24", volume="14", pages="e72032", keywords="opioid use", keywords="case-control", keywords="unintended opioid use", keywords="prolonged opioid use", keywords="prospective", abstract="Background: Misuse of prescription opioids remains a public health problem. Appropriate short-term use of these medications in opioid-naive patients is indicated in selected settings but can result in unintended prolonged opioid use (UPOU), defined as the continuation of opioid therapy beyond the period by which acute pain would have been expected to resolve. Clinical strategies aimed at preventing UPOU are lacking due to the absence of information about how this poorly understood clinical phenomenon actually develops. Objective: In this research project, 3 Clinical and Translational Science Awards (CTSA) programs (Mayo Clinic, University of Michigan, and Yale University) leveraged the conceptual framework for UPOU to investigate how patient characteristics, practice environment characteristics, and opioid prescriber characteristics facilitate or impede UPOU. All data management and analyses were conducted at a fourth CTSA program (University of Minnesota). This work was accomplished by pursuing 3 specific aims. Methods: In aim 1, opioid-naive adults receiving an initial opioid prescription were recruited for study participation. Opioid prescriptions were identified longitudinally, and patterns of use were categorized as short-term, episodic, or long-term use using established criteria. Using a prospective case-control design, patients progressing to UPOU were matched 1:1 with patients who did not develop UPOU, and differences in patient characteristics were assessed. In aim 2, clinicians who prescribed opioids to patients in aim 1 were identified and recruited for prospective assessments. Institutional and individual practice environments were assessed using a validated self-report survey. In aim 3, structural equation modeling was used to evaluate data collected in aims 1 and 2, and identified interactions were further evaluated in a large national administrative claims database. Results: Patient recruitment began on August 1, 2019. However, due to the COVID-19 pandemic, patient recruitment was slowed and intermittently interrupted over the ensuing 3-year period. As a result of regional variations in the impact of the COVID-19 pandemic on research activities, the majority of patient and clinician recruitment occurred at the Mayo Clinic site. Conclusions: Following complete data analyses, it is anticipated that electronic health record systems will be leveraged to help clinicians identify at risk patients and to develop direct-to-patient educational materials to raise awareness of the risk factors for developing UPOU. Trial Registration: ClinicalTrials.gov NCT04024397; https://clinicaltrials.gov/study/NCT04024397 International Registered Report Identifier (IRRID): DERR1-10.2196/72032 ", doi="10.2196/72032", url="https://www.researchprotocols.org/2025/1/e72032", url="http://www.ncbi.nlm.nih.gov/pubmed/39992690" } @Article{info:doi/10.2196/68292, author="Edwards, A. Karlyn and Dildine, C. Troy and You, S. Dokyoung and Herrick, M. Ashley and Darnall, D. Beth and Mackey, C. Sean and Ziadni, S. Maisa", title="Zoom-Delivered Empowered Relief for Chronic Pain: Observational Longitudinal Pilot Study Exploring Feasibility and Pain-Related Outcomes in Patients on Long-Term Opioids", journal="JMIR Form Res", year="2025", month="Mar", day="11", volume="9", pages="e68292", keywords="Empowered Relief", keywords="single session", keywords="chronic pain", keywords="prescription opioids", keywords="telehealth", keywords="daily data", keywords="pain intensity", keywords="pain catastrophizing", abstract="Background: Patients with chronic pain on long-term opioid therapy often face barriers to accessing effective nonpharmacological treatments, including the burden of multiple sessions, lack of trained clinicians, and travel time. Empowered Relief (ER), a 2-hour, single-session pain relief skills class, can improve pain and quality of life among patients with chronic pain when delivered in person or virtually. Objective: This study examined the impact of Zoom-delivered ER among people with chronic pain on long-term opioid therapy. We assessed (1) the feasibility and acceptability of Zoom-delivered ER; (2) changes in pain and opioid use outcomes at 3 and 6 months after treatment; and (3) daily associations among pain, opioid dose, and the Pain Catastrophizing Scale (PCS) before and after treatment. Methods: During the early COVID-19 pandemic, we conducted an uncontrolled pilot study of a Zoom-delivered ER among 60 adults (n=45, 76\% female participants; n=52, 88\% White participants) experiencing chronic pain who were receiving daily prescribed opioids (?10 morphine-equivalent daily dose). Participants completed assessments at enrollment, before class, after class, 3 months after treatment, and 6 months after treatment. Furthermore, participants completed 2 daily assessment periods (spanning 14 consecutive days) before and after the class. We used a multilevel modeling approach to examine (1) the raw changes in PCS, average pain intensity, pain interference, and self-reported opioid dose at 3 and 6 months after treatment and (2) daily-level changes in average pain intensity and opioid dose before and after the class. Results: Of the 60 participants enrolled, 41 (68\%) attended the class and 24 (59\% of the 41 class attendees) reported satisfaction with the Zoom-delivered class. PCS score was significantly reduced at 3 months ($\beta$=--3.49, P=.01; Cohen d=0.35) and 6 months after treatment ($\beta$=--3.61, P=.01; Cohen d=0.37), and pain intensity was significantly reduced at 3 months ($\beta$=--0.56, P=.01; Cohen d=0.39) compared to enrollment. There were no significant reductions in pain interference or opioid dose. Across daily assessments, higher daily pain catastrophizing was associated with worse daily pain ($\beta$=.42, P<.001) and higher self-reported opioid use ($\beta$=3.14, P<.001); daily pain intensity significantly reduced after the class ($\beta$=--.50, P<.001). People taking prescribed opioids as needed trended toward decreasing their daily opioid use after the class ($\beta$=--9.31, P=.02), although this result did not survive correction for multiplicity. Conclusions: Improvements to future Zoom-delivered ER iterations are needed to improve feasibility and acceptability among people with chronic pain and daily prescribed opioid use. Despite this, findings show a promising preliminary impact of the intervention on pain outcomes. A larger randomized controlled trial of Zoom-delivered ER among this patient population is currently under way. ", doi="10.2196/68292", url="https://formative.jmir.org/2025/1/e68292" } @Article{info:doi/10.2196/59954, author="Newman, E. Jamie and Clarke, Leslie and Athimuthu, Pranav and Dhawan, Megan and Owen, Sharon and Beiersdorfer, Traci and Parlberg, M. Lindsay and Bangdiwala, Ananta and McMillan, Taya and DeMauro, B. Sara and Lorch, Scott and Peralta-Carcelen, Myriam and Wilson-Costello, Deanne and Ambalavanan, Namasivayam and Merhar, L. Stephanie and Poindexter, Brenda and Limperopoulos, Catherine and Davis, M. Jonathan and Walsh, Michele and Bann, M. Carla", title="Supplementing Consent for a Prospective Longitudinal Cohort Study of Infants With Antenatal Opioid Exposure: Development and Assessment of a Digital Tool", journal="JMIR Form Res", year="2025", month="Mar", day="4", volume="9", pages="e59954", keywords="informed consent digital tool", keywords="avatars", keywords="video-assisted consent", keywords="MRI", keywords="antenatal opioid exposure", keywords="infant", keywords="antenatal", keywords="opioid exposure", keywords="caregiver", keywords="survey", keywords="magnetic resonance imaging", keywords="Outcomes of Babies With Opioid Exposure", abstract="Background: The Outcomes of Babies With Opioid Exposure (OBOE) study is an observational cohort study examining the impact of antenatal opioid exposure on outcomes from birth to 2 years of age. COVID-19 social distancing measures presented challenges to research coordinators discussing the study at length with potential participants during the birth hospitalization, which impacted recruitment, particularly among caregivers of unexposed (control) infants. In response, the OBOE study developed a digital tool (consenter video) to supplement the informed consent process, make it more engaging, and foster greater identification with the research procedures among potential participants. Objective: We aim to examine knowledge of the study, experiences with the consent process, and perceptions of the consenter video among potential participants of the OBOE study. Methods: Analyses included 129 caregivers who were given the option to view the consenter video as a supplement to the consent process. Participants selected from 3 racially and ethnically diverse avatars to guide them through the 11-minute video with recorded voice-overs. After viewing the consenter video, participants completed a short survey to assess their knowledge of the study, experiences with the consent process, and perceptions of the tool, regardless of their decision to enroll in the main study. Chi-square tests were used to assess differences between caregivers of opioid-exposed and unexposed infants in survey responses and whether caregivers who selected avatars consistent with their racial or ethnic background were more likely to enroll in the study than those who selected avatars that were not consistent with their background. Results: Participants demonstrated good understanding of the information presented, with 95\% (n=123) correctly identifying the study purpose and 88\% (n=112) correctly indicating that their infant would not be exposed to radiation during the magnetic resonance imaging. Nearly all indicated they were provided ``just the right amount of information'' (n=123, 98\%) and that they understood the consent information well enough to decide whether to enroll (n=125, 97\%). Survey responses were similar between caregivers of opioid-exposed infants and unexposed infants on all items except the decision to enroll. Those in the opioid-exposed group were more likely to enroll in the main study compared to the unexposed group (n=49, 89\% vs n=38, 51\%; P<.001). Of 81 caregivers with known race or ethnicity, 35 (43\%) chose avatars to guide them through the video that matched their background. Caregivers selecting avatars consistent with their racial or ethnic background were more likely to enroll in the main study (n=29, 83\% vs n=43, 57\%; P=.01). Conclusions: This interactive digital tool was helpful in informing prospective participants about the study. The consenter tool enhanced the informed consent process, reinforced why caregivers of unexposed infants were being approached, and was particularly helpful as a resource for families to understand magnetic resonance imaging procedures. Trial Registration: ClinicalTrials.gov NCT04149509; https://clinicaltrials.gov/study/NCT04149509 ", doi="10.2196/59954", url="https://formative.jmir.org/2025/1/e59954" } @Article{info:doi/10.2196/59338, author="Zhang, Xinyu and Zhu, Jianfeng and Kenne, R. Deric and Jin, Ruoming", title="Teenager Substance Use on Reddit: Mixed Methods Computational Analysis of Frames and Emotions", journal="J Med Internet Res", year="2025", month="Feb", day="19", volume="27", pages="e59338", keywords="teenager", keywords="substance use", keywords="Reddit", keywords="emotional analysis", keywords="bidirectional encoder representations from transformers", keywords="BERT", keywords="frame approach", abstract="Background: Adolescent substance use disorder is a pressing public health issue, with increasing prevalence as individuals age. Social media platforms like Reddit (Reddit Inc) serve as significant venues for teenagers to discuss and navigate substance use. Social media platforms, such as Reddit, serve as increasingly important spaces where teenagers discuss, share, and navigate their experiences with substance use, presenting unique opportunities and challenges for understanding and addressing this issue. Objective: This study aims to explore how teenagers frame substance-use discussions on the r/teenagers subreddit, focusing on their personal interpretations, causal attributions, and the social and psychological contexts that shape these online support groups. By identifying these interpretive frames, we aimed to better understand the complex drivers of adolescent substance use behavior and their potential interventions. Methods: Using natural language processing techniques, we analyzed 32,674 substance use--related posts from 2018 to 2022. A framing approach was used to identify and categorize prevalent themes, supplemented by emotional profiling using the EmoLLaMA-chat-13B model developed by Liu and colleagues. Results: In total, 7 primary frames emerged: normalization, risk awareness, social integration, autonomy and rebellion, coping mechanisms, media influence, and stigmatization. These frames varied in prevalence and were associated with distinct emotional profiles, highlighting the complex interplay between substance use and adolescent experiences. We observed that, for example, the normalization frame was often associated with a mix of sadness and anxiety, while the coping frame exhibited elevated levels of anger, sadness, and anxiety. These distinctive emotional landscapes associated with each frame reveal unique insights into the mental state of adolescents navigating substance use. Conclusions: The findings underscore the multifaceted nature of adolescent substance-use discussions on social media. Interventions must address underlying emotional and social factors as well as identity to effectively mitigate substance use disorder among adolescents. By understanding the frames teenagers use to interpret substance use, we can pave the way for more effective and personalized public health campaigns, and support services designed to resonate with adolescents' unique lived experiences. ", doi="10.2196/59338", url="https://www.jmir.org/2025/1/e59338" } @Article{info:doi/10.2196/60038, author="Fitzgerald, Haley and Frank, Madison and Kasula, Katelyn and Krans, E. Elizabeth and Krishnamurti, Tamar", title="Usability and Acceptability of a Pregnancy App for Substance Use Screening and Education: A Mixed Methods Exploratory Pilot Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="13", volume="8", pages="e60038", keywords="substance use disorder", keywords="substance use screening", keywords="mHealth", keywords="mobile health apps", keywords="pregnancy", keywords="technology", abstract="Background: Increasing opioid and other substance use has led to a crisis of epidemic proportions, with substance use now recognized as a leading cause of maternal morbidity and mortality in the United States. Interventions will only be effective if those who would benefit are identified early and connected to care. Apps are a ubiquitous source of pregnancy information, but their utility as a platform for evaluating substance use during pregnancy is unknown. Objective: This study aims to explore the usability and acceptability of a pregnancy app for opioid and other substance use screening and education. Methods: This mixed methods, exploratory pilot study examined adult pregnant people with a history of substance use who were recruited from outpatient and inpatient settings at a tertiary care obstetric hospital. After completing a baseline survey collecting demographics, substance use, and technology use, participants accessed an existing pregnancy support app for 4 weeks. Qualitative methods were used to measure the acceptability of embedding substance use screening, education, and information within the tool. App use frequency and access to substance use educational content and treatment referral information were evaluated. Results: The 28 female participants had a mean (SD) age of 31 (0.46) years; most were White (21/28, 75\%) and Medicaid insured (26/28, 93\%), with an annual household income of