{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T06:42:45Z","timestamp":1793515365817,"version":"4.5.0"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":68,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study examines differences between major city and regional and remote participants in engagement in a digital alcohol support intervention (Daybreak), risky drinking, and psychological distress and tests the mediating role of psychological distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a longitudinal, observational cohort study of Daybreak participants between January 2019 and December 2024 (\n                      <jats:italic>N<\/jats:italic>\n                      = 12,824). Outcomes were risky drinking and psychological distress. Ordered logistic regression examined associations between the outcomes and program engagement, and multilevel generalized structural equation modeling tested mediation by psychological distress.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>At 6 months, risky drinking scores declined by 42% in major city participants and 57% in regional and remote participants. High engagement in reacting to posts reduced risky drinking in both metro (OR = 0.47, 95% CI 0.27\u20130.80) and regional and remote areas (OR = 0.42, 95% CI 0.18\u20130.99). High engagement in post sharing was associated with lower odds of high risky drinking only in major city participants (OR = 0.56, 95% CI 0.33\u20130.98). In regional areas, participants who aimed to quit drinking at registration had lower risky drinking (OR = 0.72, 95% CI 0.53\u20130.99), while longer program inactivity increased odds of psychological distress (OR = 1.95, 95% CI 1.13\u20133.38). Psychological distress mediated 56% of the association between post reactions and risky drinking in major city participants and 33% in regional and remote participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Distinct engagement pathways across regional and remote and major city settings suggest the need for more flexible digital program designs. Psychological distress, as a partial mediator, should be both a treatment target and a mechanism of change.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70192","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T09:56:09Z","timestamp":1786182969000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["More Than Activity: The Effect of Sustained Engagement in Digital Alcohol Support Interventions for Regional and Remote Communities"],"prefix":"10.1111","volume":"42","author":[{"given":"Katinka van de","family":"Ven","sequence":"first","affiliation":[{"name":"Hello Sunday Morning  Crows Nest New South Wales Australia"},{"name":"360Edge  Elwood Victoria Australia"},{"name":"Drug Policy Modelling Program, Social Policy Research Centre University of NSW  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getenet","family":"Dessie","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, College of Law, Governance and Policy Australian National University, Canberra  Australian Capital Territory Australia"},{"name":"College of Medicine and Health Science Bahr Dar University  Bahr Dar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3797-5234","authenticated-orcid":false,"given":"Kedir Y.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Rural Health Research Institute (RHRI) Charles Sturt University  Orange New South Wales Australia"},{"name":"Translational Health Research Institute Western Sydney University, Campbelltown Campus, Penrith  New South Wales Australia"},{"name":"Discipline of General Practice, School of Medicine Adelaide University  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Lee","sequence":"additional","affiliation":[{"name":"Hello Sunday Morning  Crows Nest New South Wales Australia"},{"name":"360Edge  Elwood Victoria Australia"},{"name":"National Drug Research Institute Curtin University, Perth  Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5816-4548","authenticated-orcid":false,"given":"Hazel","family":"Dalton","sequence":"additional","affiliation":[{"name":"Rural Health Research Institute (RHRI) Charles Sturt University  Orange New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9299-5866","authenticated-orcid":false,"given":"Julaine","family":"Allan","sequence":"additional","affiliation":[{"name":"Rural Health Research Institute (RHRI) Charles Sturt University  Orange New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1182-8511","authenticated-orcid":false,"given":"Subash","family":"Thapa","sequence":"additional","affiliation":[{"name":"Rural Health Research Institute (RHRI) Charles Sturt University  Orange New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders","year":"2024"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12014"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1584.2010.01133.x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00159-6"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.22605\/RRH4155"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40429-022-00454-3"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2021.100439"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638237.2023.2245902"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.2196\/17046"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.2196\/35159"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.2196\/11831"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psycom.2024.100183"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.2196\/14967"},{"key":"e_1_2_10_15_1","article-title":"Feasibility and Acceptability of the Daybreak Drink Tracker","volume":"8","author":"Fletcher K.","year":"2024","journal-title":"JMIR mHealth and uHealth"},{"issue":"3","key":"e_1_2_10_16_1","first-page":"1","article-title":"Online SMART Recovery Manual\u2010Help Groups: A Comparison of the Characteristics and Experience of Men Living in Rural and Urban Regions of Australia","volume":"24","author":"Ven K.","year":"2024","journal-title":"Rural and Remote Health"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12076"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2023.104174"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1479"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-020-00190-x"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/23.134"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12737"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2010.03.002"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.3928\/02793695\u201020080901\u201005"},{"key":"e_1_2_10_25_1","unstructured":"Quarterly Impact Report: April\u2014June 2025(Sydney Australia: Hello Sunday Morning 2025)."},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/hpja.70161"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.2196\/48245"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1181046"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1080\/00048670601109949"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2000.tb02093.x"},{"key":"e_1_2_10_31_1","first-page":"47","article-title":"Smartphone Applications to Reduce Alcohol Consumption and Help Patients With Alcohol Use Disorder: A State\u2010of\u2010the\u2010Art Review","volume":"1","author":"Meredith S. E.","year":"2015","journal-title":"Advanced Health Care Technologies"},{"key":"e_1_2_10_32_1","volume-title":"Rural and Remote Health","year":"2025"}],"container-title":["The Journal of Rural Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70192","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jrh.70192","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70192","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:07:10Z","timestamp":1789992430000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jrh.70192"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":31,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/jrh.70192"],"URL":"https:\/\/doi.org\/10.1111\/jrh.70192","archive":["Portico"],"relation":{},"ISSN":["0890-765X","1748-0361"],"issn-type":[{"value":"0890-765X","type":"print"},{"value":"1748-0361","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-09-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70192"}}