Developing an Online and SMS Intervention to Increase Protective Behavioral Strategy Use in Young Adults Using Alcohol and Cannabis

Background and purpose: This study describes the development of an online and text-messaging intervention aimed at augmenting protective behavioral strategy (PBS) utilization at the daily level among young adults engaged in alcohol and cannabis use. PBS, encompassing tips and strategies to moderate alcohol and cannabis use and reduce associated risks, have been integral components of individual-level interventions. PBS can vary in both quality and consistency, two distinct but related dimensions of use. Quality of PBS use refers to the degree to which a strategy is implemented in its most effective form to maximize harm reduction, whereas consistency of PBS use reflects the frequency and reliability with which an individual engages in a strategy across multiple substance use occasions. The quality and consistency of PBS use have been underexplored in intervention frameworks.

Methods: Participants (N = 40; Mage = 21.55, SD = 1.89; 50% female) were young adults age 18 to 24 in Texas who had regular monthly alcohol and cannabis use. We conducted 6 initial focus groups and 13 cognitive interviews with young adults who used alcohol and cannabis to learn the motivations underpinning alcohol and cannabis PBS utilization, barriers impeding PBS use, and PBS use with high quality and consistency. This step served as the cornerstone for crafting targeted intervention strategies. Drawing from the insights from the focus groups and cognitive interviews, we developed an interactive online intervention and text message platform. Following this step, we conducted 3 additional focus groups and 9 cognitive interviews with young adults to gain insight on intervention materials and to implement any needed changes before deploying the final intervention.

Results: The qualitative findings highlighted diverse motivations guiding PBS use, including safety concerns, productivity maintenance, health and fitness considerations, financial impacts, and avoiding negative consequences such as hangovers. Conversely, social pressures, ambiguous perceptions of quantity moderation, and practical barriers like limited access to non-alcoholic drinks were identified as challenges affecting consistent PBS use. Participants also indicated variability in the quality of PBS use, influenced by situational contexts such as social environments and transportation logistics. We present the final iteration of the intervention, which consisted of a brief, web-based intervention followed by text messages 3 days a week for 8 consecutive weeks as well as two monthly daily-level summaries of behaviors reported across 8 weeks.

Conclusions: This study illustrates a rigorous, iterative design process for developing an intervention responsive to young adults' real-world experiences with alcohol and cannabis. Findings underscore the necessity of personalized and adaptive intervention frameworks that integrate motivational and practical considerations that influence PBS use. This formative work highlights the importance of directly engaging intervention end-users in the design process, ultimately enhancing the relevance, acceptability, and potential effectiveness of substance-use harm reduction interventions for young adults. This work directly aligns with social work practice by emphasizing the importance of a person-centered approach, where social work researchers and practitioners collaborate with individuals to co-create interventions that are tailored to their unique needs and experiences, fostering empowerment and promoting positive change within diverse communities.