Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Trace Kershaw


Background - Alcohol and marijuana use in adolescents remains widespread, pervasive and recognized as a major public health concern.

This pilot study aimed to test the feasibility of a novel health intervention that adds a 4-week series of text messaging to the Brief

Negotiation Interview (BNI; a brief motivational technique) for 13-18-year-olds with high-risk alcohol or marijuana use in an emergency department or primary care setting.

Methods -13-18-year-old patients presenting to a Children's emergency department or a primary care clinic in the Northeast were screened with the CRAFFT substance use screener. Adolescents who scored 2+ on the CRAFFT were asked to participate in this study. After obtaining written consent and/or assent and parental permission, adolescent participants completed baseline surveys, participated in a BNI with a trained research assistant, and enrolled in the 4-week text messaging program, which consisted of weekly goal setting and reflection exercises. Participants completed an in-depth interview to assess satisfaction at 4 weeks post-enrollment. Feasibility measures include enrollment, retention, and satisfaction.

Results - Between November 2017 and May 2018, we screened 71 adolescents. We obtained parental consent and adolescent assent to enroll 10 of 27 eligible participants (37%), of which 8/10 (80%) completed the 4-week text messaging intervention. Analysis of the 494 reflection and goal setting text messages sent during the program demonstrated that participants completed a higher proportion of alcohol reflection and goal setting text message exercises (85% and 70%, respectively) than marijuana exercises (both 64%). From the open-ended interviews, 43% of active participants believed the exercises gave good ideas on how to quit alcohol and marijuana use. Further, 100% liked the content of the messages received and would recommend the program to a friend.

Conclusions - These data indicate that, although it is challenging to identify and enroll adolescents with high-risk alcohol and/or marijuana use in medical settings, adolescents who enroll are generally satisfied with the intervention, supported by high levels of retention. The feasibility data suggest that text messaging programs may need to improve parental engagement models and refine texts to enhance motivation to change marijuana use. Future research is needed to continue exploring the sophisticated role of tailored texting in improving adolescent behavior.


This is an Open Access Thesis.

Open Access

This Article is Open Access