MiREA, a mHealth intervention to Reduce Health Disparities by Improving Equitable Access to Mandated College Students with Problematic Alcohol and Marijuana Use

ABSTRACT This STTR Phase I proposal is designed to address the urgent need for an effective primary prevention approach to the problem of heavy episodic drinking and cannabis misuse among mandated college students attending Colleges and Universities. Alcohol and cannabis misuse affects all demographic groups in the United States (NSDUH, 2021); however, some subsets are disproportionally affected. With growing evidence of health disparities among college students, the COVID-19 pandemic has decimated college budgets and elevated the risk of substance misuse and mental health issues. Smartphone app interventions are expanding and can offer accessible, scalable, and cost-effective tools. Cannabis use has increased significantly among Americans aged 18 and up in 2015-2018 (NSDUH, 2020). Alcohol death rates among college-age students (18 to 34) jumped 69% from 2007 to 2020. Cannabis is the most widely used illicit drug among the country’s 20-plus million college students. Research suggests that newer technologies, such as smartphone apps, prevent misuse in mandated students more effectively than face-to-face intervention. However, little research has been done into evidence-based interventions that empower students to engage in health-seeking behaviors and avoid risky alcohol and cannabis misuse. To address this gap, mHealth Systems, Inc. is partnering with the University of NC at Charlotte (UNCC), the University of South Carolina USC), and Harvard Medical School Teaching Hospital on this Phase I STTR. We will enhance the Motivational Intervention in Real-time delivered through the Ecological Application (MiREA) App by expanding to incorporate further refined content. Phase 1 will test the adapted product’s feasibility and acceptability. Specific aims: 1) Determine usability, feasibility, and efficacy of the MiREA-AC intervention (months 1-12); we will: a) conduct alpha theater and field testing (months 1-3, n=10) at two U.S. campuses to ensure acceptability of the app’s contents; b) conduct a multi-site pilot feasibility trial (months 3-12, n=60) at six U.S. campuses. 2) Examine key customer needs by engaging with a Stakeholders Advisory Board (SAB, n=50, months 1-12) composed of health wellness staff, administrators, and representatives from colleges and universities and engage the SAB in the integration of MiREA-AC prototype within mandated programs. Participants will include 60 students from six US universities, ages 18 to 25. Because of students’ comfort with mobile technologies, we expect those receiving digital intervention to report higher satisfaction with the MiREA-AC mobile app than with in-person interventions. We expect MiREA-AC to be more cost-effective and to have greater reach, adoptability, portability, and sustainability than current approaches.