W. Gill Woodall

Driving while intoxicated (DWI) remains a preventable source of morbidity and mortality in the United States. Ignition Interlock Devices (IID) are used to prevent DWI offenders from driving while intoxicated during a mandated installation period and are effective during that time. Once IIDs are removed, DWI rates are similar to levels of offenders who had no IID. This study tested the efficacy of a smartphone app (B-SMART) for DWI offenders with an IID and Concerned Family Members (CFMs), with the goal of reducing IID lockout events and alcohol consumption. Four B-SMART app modules were developed: 1) Life with Interlock, 2) Supporting Changes in Drinking, 3) Doing Things Together, and 4) Effective Communication. Participants (pairs of DWI offenders and CFMs) were randomly assigned to receive the B-SMART app (n=58) or referral to a state IID information page (Usual and Customary - UC condition, n=65) and followed for 9 months post-randomization. IID data (failed tests and lockout events) were obtained from IID providers as the primary outcome variables. Offender and CFM reports of alcohol consumption in the last 30 days prior to assessment were secondary measures. IID data were collected on 62% (N=76) of participants. B-SMART participants had significantly fewer lockout events than UC participants. B-SMART offenders and their CFMs reported significantly less likelihood of DWI offender drinking at 9-months. Results suggest the B-SMART app reduced IID lockout events and DWI offender alcohol consumption. These outcomes are important because fewer IID lockout events predict lower DWI recidivism.

Background: Effectiveness of statutes to combat hazardous polysubstance use has rarely been evaluated. Compliance with a state law prohibiting recreational cannabis sales to apparently intoxicated customers was assessed in one of the first states to legalize cannabis sales. Methods: In January to June 2024, pseudo‐patrons twice visited recreational cannabis stores ( n = 189) in two large metropolitan areas and attempted to purchase cannabis while displaying alcohol intoxication behaviors. Observers recorded whether sellers were willing to sell the product along with characteristics of the stores (busyness, cleanliness, and signage) and cannabis sellers (sex, race and ethnicity, and age). Neighborhood characteristics by US census tract were obtained (income, race, and ethnicity; population density). Sex and race and ethnicity of the pseudo‐patrons, and extent and type of intoxication cues, were recorded. Descriptive statistics and logistic regression were used to describe the sales rate and predictors of the sales rate. Results: Assessments were completed at 173 stores. Sellers were willing to sell cannabis to pseudo‐intoxicated buyers at 255 of 346 visits (73.7%; 26.3% refused). Sellers refused buyers at both visits in 6.9% of stores but in 54.3% were willing to sell at both visits. Sellers refused cannabis sales at higher rates in stores with signs saying, “no sales to intoxicated customers” (34.3%, p = 0.04), particularly when buyers displayed more obvious signs of intoxication (39.8%, p = 0.049). Conclusions: Low compliance with the state regulation possibly occurred because sellers were unaware of the law, perceived little deterrence, or lacked the skills to recognize and refuse intoxicated customers. Policy Implications: Noncompliance with the law on selling cannabis to apparently alcohol‐intoxicated customers increases the risks of polysubstance impairment and harm.

Background: The rapid growth of user-generated web-based health information increases the complexity of cancer information seeking. One promising strategy for promoting high-quality cancer information consumption is through targeted interventions that are intentionally designed to reach individuals in the web-based spaces they occupy. However, there is a paucity of evidence-based information on the best strategies for designing and implementing web-based health behavior change interventions to improve individuals’ cancer-related knowledge and prevent cancer. Objective: This study aimed to develop and pilot test a theory-based intervention via the web to reduce 6 cancer risk factors among rural emerging adults (EAs) through community-engaged research. Methods: This mixed methods evaluation describes the development of a web-based cancer prevention intervention aimed at rural EAs aged 18-26 years in the United States and delivered in Facebook private groups. The intervention was guided by behavior change theory and cocreated with EA and Stakeholder Organization Advisory Boards to ensure relevance, accessibility, and appropriateness. We report on 3 formative surveys, a pilot intervention, protocol development, and the community-engaged process for intervention development. Descriptive statistics were applied to the surveys and pilot intervention baseline results to produce means and SDs using R. Results: We developed posts (n=400) for a Facebook feed aimed at reducing 6 cancer risk behaviors (unhealthy diet, lack of physical activity, tobacco use, alcohol use, sun exposure, and human papillomavirus infection) with iterative input from the EA and stakeholder advisory boards. Formative surveys with rural EAs (n=297) and a pilot study of the intervention with this population (n=26) were conducted. In the pilot study, the intervention reached participants across rural counties, with sustained engagement (post views=1060, reactions=346, comments=72) over a one-month period. Key modifications to the intervention content and design emerged from both advisory boards, the formative surveys, and the pilot intervention, focusing on using perceived reliable sources and direct links to source material. Conclusions: This web-based cancer prevention intervention is scalable and delivers engaging, evidence-informed health information to rural EAs. We offer key insights into the design and implementation of web-based cancer prevention interventions for EAs by describing the resources, timelines, and expertise needed to design and implement the intervention. Considerations for fully engaging EA and community stakeholder partners are presented, and we discuss how their involvement resulted in modifications that strengthened the intervention. Finally, we highlight the importance of theory-based health-behavior messaging, digital messaging skillsets, and platform-tailored dissemination strategies for maximizing web-based intervention acceptability. Trial Registration: ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158 International Registered Report Identifier (IRRID): RR2-10.2196/50392

BACKGROUND The rapid growth of user-generated web-based health information increases the complexity of cancer information seeking. One promising strategy for promoting high-quality cancer information consumption is through targeted interventions that are intentionally designed to reach individuals in the web-based spaces they occupy. However, there is a paucity of evidence-based information on the best strategies for designing and implementing web-based health behavior change interventions to improve individuals’ cancer-related knowledge and prevent cancer. OBJECTIVE This study aimed to develop and pilot test a theory-based intervention via the web to reduce 6 cancer risk factors among rural emerging adults (EAs) through community-engaged research. METHODS This mixed methods evaluation describes the development of a web-based cancer prevention intervention aimed at rural EAs aged 18-26 years in the United States and delivered in Facebook private groups. The intervention was guided by behavior change theory and cocreated with EA and Stakeholder Organization Advisory Boards to ensure relevance, accessibility, and appropriateness. We report on 3 formative surveys, a pilot intervention, protocol development, and the community-engaged process for intervention development. Descriptive statistics were applied to the surveys and pilot intervention baseline results to produce means and SDs using R. RESULTS We developed posts (n=400) for a Facebook feed aimed at reducing 6 cancer risk behaviors (unhealthy diet, lack of physical activity, tobacco use, alcohol use, sun exposure, and human papillomavirus infection) with iterative input from the EA and stakeholder advisory boards. Formative surveys with rural EAs (n=297) and a pilot study of the intervention with this population (n=26) were conducted. In the pilot study, the intervention reached participants across rural counties, with sustained engagement (post views=1060, reactions=346, comments=72) over a one-month period. Key modifications to the intervention content and design emerged from both advisory boards, the formative surveys, and the pilot intervention, focusing on using perceived reliable sources and direct links to source material. CONCLUSIONS This web-based cancer prevention intervention is scalable and delivers engaging, evidence-informed health information to rural EAs. We offer key insights into the design and implementation of web-based cancer prevention interventions for EAs by describing the resources, timelines, and expertise needed to design and implement the intervention. Considerations for fully engaging EA and community stakeholder partners are presented, and we discuss how their involvement resulted in modifications that strengthened the intervention. Finally, we highlight the importance of theory-based health-behavior messaging, digital messaging skillsets, and platform-tailored dissemination strategies for maximizing web-based intervention acceptability. CLINICALTRIAL ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158 INTERNATIONAL REGISTERED REPORT RR2-10.2196/50392

Background: Improved interventions are needed to reduce the rate of driving while intoxicated. Responsible beverage service (RBS) training has reduced service to intoxicated patrons in licensed premises in several studies. Its efficacy might be improved by increasing the proper application and continued use of RBS with a professional development program in the 3 to 5 years between the required RBS retraining. Objective: This study aims to develop and evaluate a professional development component for an RBS training that aims to improve the effectiveness of the web-based training alone. Methods: In a 2-phase project, we are creating a professional development component for alcohol servers after completing an RBS training. The first phase involved formative research on the feasibility, acceptability, and potential effectiveness of components. Semistructured interviews with owners and managers of licensed establishments and focus groups and a survey with alcohol servers in New Mexico and Washington State examined support for RBS and the need for ongoing professional development to support RBS. A prototype of a professional development component, WayToServe Plus, was produced for delivery in social media posts on advanced RBS skills, support from experienced servers, professionalism, and basic management training. The prototype was evaluated in a usability survey and a field pilot study with alcohol servers in California, New Mexico, and Washington State. The second phase of the project will include full production of the professional development component. It will be delivered in Facebook private groups over 12 months and evaluated with a sample of licensed premises (ie, bars and restaurants) in California, New Mexico, and Washington State (n=180) in a 2-group randomized field trial (WayToServe training only vs WayToServe training and WayToServe Plus). Licensed establishments will be assessed for refusal of sales to apparently intoxicated pseudopatrons at baseline and 12 months after the intervention commences. Results: Although owners and managers (n=10) and alcohol servers (n=43) were favorable toward RBS, they endorsed the need for ongoing support for RBS for servers and identified topics of interest. A prototype with 50 posts was successfully created. Servers felt that it was highly usable and appropriate for themselves and the premises in the usability survey (n=20) and field pilot test (n=110), with 85% (17/20) and 78% (46/59), respectively, saying they would use it. Servers receiving the professional development component had higher self-efficacy (d=0.30) and response efficacy (d=0.38) for RBS compared with untreated controls. Conclusions: Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed premises. Servers were interested in using such a program, a large majority engaged with the prototype, and servers receiving it improved on theoretic mediators of RBS. Thus, the professional development component may improve RBS training. Trial Registration: ClinicalTrials.gov NCT05779774; http://tinyurl.com/4mw6d2vk

BACKGROUND Improved interventions are needed to reduce the rate of driving while intoxicated. Responsible beverage service (RBS) training has reduced service to intoxicated patrons in licensed premises in several studies. Its efficacy might be improved by increasing the proper application and continued use of RBS with a professional development program in the 3 to 5 years between the required RBS retraining. OBJECTIVE This study aims to develop and evaluate a professional development component for an RBS training that aims to improve the effectiveness of the web-based training alone. METHODS In a 2-phase project, we are creating a professional development component for alcohol servers after completing an RBS training. The first phase involved formative research on the feasibility, acceptability, and potential effectiveness of components. Semistructured interviews with owners and managers of licensed establishments and focus groups and a survey with alcohol servers in New Mexico and Washington State examined support for RBS and the need for ongoing professional development to support RBS. A prototype of a professional development component, WayToServe Plus, was produced for delivery in social media posts on advanced RBS skills, support from experienced servers, professionalism, and basic management training. The prototype was evaluated in a usability survey and a field pilot study with alcohol servers in California, New Mexico, and Washington State. The second phase of the project will include full production of the professional development component. It will be delivered in Facebook private groups over 12 months and evaluated with a sample of licensed premises (ie, bars and restaurants) in California, New Mexico, and Washington State (n=180) in a 2-group randomized field trial (WayToServe training only vs WayToServe training and WayToServe Plus). Licensed establishments will be assessed for refusal of sales to apparently intoxicated pseudopatrons at baseline and 12 months after the intervention commences. RESULTS Although owners and managers (n=10) and alcohol servers (n=43) were favorable toward RBS, they endorsed the need for ongoing support for RBS for servers and identified topics of interest. A prototype with 50 posts was successfully created. Servers felt that it was highly usable and appropriate for themselves and the premises in the usability survey (n=20) and field pilot test (n=110), with 85% (17/20) and 78% (46/59), respectively, saying they would use it. Servers receiving the professional development component had higher self-efficacy (d=0.30) and response efficacy (d=0.38) for RBS compared with untreated controls. CONCLUSIONS Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed premises. Servers were interested in using such a program, a large majority engaged with the prototype, and servers receiving it improved on theoretic mediators of RBS. Thus, the professional development component may improve RBS training. CLINICALTRIAL ClinicalTrials.gov NCT05779774; http://tinyurl.com/4mw6d2vk INTERNATIONAL REGISTERED REPORT DERR1-10.2196/49680

Misinformation can undermine public health recommendations. Our team evaluated a 9-week social media campaign promoting COVID-19 prevention to mothers (n = 303) of teen daughters in January-March 2021. We implemented an epidemiological model for monitoring, diagnosing, and responding quickly to misinformation from mothers. Overall, 54 comments out of 1617 total comments (3.3%) from 20 mothers (6.6% of sample) contained misinformation. Misinformation was presented in direct statements and indirectly as hypothetical questions, source derogation, and personal stories, and attributed to others. Misinformation occurred most (n = 40; 74%) in comments on vaccination posts. The community manager responded to 48 (89%) misinformation comments by acknowledging the comment and rebutting misinformation. No mothers who provided misinformation left the Facebook groups and a few commented again (n = 10) or reacted (n = 3) to responses. Only a small number of comments conveyed misinformation. Our quick-response epidemiological protocol appeared to prevent debate and dropout and exposed these mothers to credible information.

Background: Social media disseminated information and spread misinformation during the COVID-19 pandemic that affected prevention measures, including social distancing and vaccine acceptance. Objective: In this study, we aimed to test the effect of a series of social media posts promoting COVID-19 nonpharmaceutical interventions (NPIs) and vaccine intentions and compare effects among 3 common types of information sources: government agency, near-peer parents, and news media. Methods: A sample of mothers of teen daughters (N=303) recruited from a prior trial were enrolled in a 3 (information source) × 4 (assessment period) randomized factorial trial from January to March 2021 to evaluate the effects of information sources in a social media campaign addressing NPIs (ie, social distancing), COVID-19 vaccinations, media literacy, and mother–daughter communication about COVID-19. Mothers received 1 social media post per day in 3 randomly assigned Facebook private groups, Monday-Friday, covering all 4 topics each week, plus 1 additional post on a positive nonpandemic topic to promote engagement. Posts in the 3 groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Mothers reported on social distancing behavior and COVID-19 vaccine intentions for self and daughter, theoretic mediators, and covariates in baseline and 3-, 6-, and 9-week postrandomization assessments. Views, reactions, and comments related to each post were counted to measure engagement with the messages. Results: Nearly all mothers (n=298, 98.3%) remained in the Facebook private groups throughout the 9-week trial period, and follow-up rates were high (n=276, 91.1%, completed the 3-week posttest; n=273, 90.1%, completed the 6-week posttest; n=275, 90.8%, completed the 9-week posttest; and n=244, 80.5%, completed all assessments). In intent-to-treat analyses, social distancing behavior by mothers (b=–0.10, 95% CI –0.12 to –0.08, P<.001) and daughters (b=–0.10, 95% CI –0.18 to –0.03, P<.001) decreased over time but vaccine intentions increased (mothers: b=0.34, 95% CI 0.19-0.49, P<.001; daughters: b=0.17, 95% CI 0.04-0.29, P=.01). Decrease in social distancing by daughters was greater in the near-peer source group (b=–0.04, 95% CI –0.07 to 0.00, P=.03) and lesser in the government agency group (b=0.05, 95% CI 0.02-0.09, P=.003). The higher perceived credibility of the assigned information source increased social distancing (mothers: b=0.29, 95% CI 0.09-0.49, P<.01; daughters: b=0.31, 95% CI 0.11-0.51, P<.01) and vaccine intentions (mothers: b=4.18, 95% CI 1.83-6.53, P<.001; daughters: b=3.36, 95% CI 1.67-5.04, P<.001). Mothers’ intentions to vaccinate self may have increased when they considered the near-peer source to be not credible (b=–0.50, 95% CI –0.99 to –0.01, P=.05). Conclusions: Decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions. When promoting COVID-19 prevention, campaign planners may be more effective when selecting information sources that audiences consider credible, as no source was more credible in general. Trial Registration: ClinicalTrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807