# Digital health interventions for women in frontline public service roles: A systematic review of effectiveness in reducing substance use

## TL;DR

Digital health tools may help reduce substance use among women in high-stress public service roles, but more research is needed to confirm their effectiveness and tailor them to women's unique needs.

## Contribution

This is the first systematic review to evaluate digital health interventions specifically for reducing substance use among women in frontline public service roles.

## Key findings

- Most studies showed significant reductions in alcohol and tobacco use after digital interventions.
- Results for PTSD symptoms, illicit drug use, and quality of life were mixed.
- Few studies focused on women, and existing samples were small and not representative.

## Abstract

Frontline occupations, including military, healthcare, and first responders, often include frequent exposure to traumatic events, increasing the risk of substance use disorders (SUDs). Research has shown that those in high-intensity occupations are at higher risk of developing SUDs compared to the general population. Women face unique experiences related to substance use, including greater functional impairment and barriers to treatment access. Yet, understanding of the effectiveness of digital health technologies in addressing substance use among women in frontline occupations is limited. This systematic review evaluates the effectiveness of digital health interventions in reducing substance use among women in frontline roles. Four databases (PsycINFO, Ovid MEDLINE, Embase, PsycArticles) were searched for English language full-text articles (2007–2024) that (1) evaluated a digital intervention designed to reduce substance use, (2) reported changes in substance use outcomes such as frequency, intensity or duration, using validated tools (3) included current or former frontline public service workers, and (4) included women as the primary target population or as a subgroup within the sample. 13 papers met inclusion criteria, focusing on eight distinct web and mobile-based interventions for alcohol, tobacco and illicit substances. Most studies (n = 11) reported substantial post-intervention reductions in alcohol and tobacco use, although results for PTSD symptoms, illicit drug use, and quality of life were mixed. This review highlights the potential of digital health interventions for reducing substance use but underscores significant gaps in research. The scarcity of studies focused on women, small and heterogeneous samples, and focus on veterans limits the generalisability to women in frontline roles. These gaps present a pressing challenge in understanding gender-specific digital intervention efficacy. Future research should prioritise larger, representative samples of women across diverse frontline occupations to drive the development of digital technologies tailored to the unique challenges faced by women in these roles.

Women in frontline public service roles, such as first responders and military personnel, are frequently exposed to trauma, placing them at heightened risk for substance use and adverse mental health outcomes. While digital health technologies, including mobile apps and web-based tools, are increasingly being developed to address these issues, their effectiveness for women remains unclear. In this review, we examined 13 studies on digital interventions targeting substance use, including alcohol, tobacco, and illicit drugs, among individuals currently or formerly in frontline occupations. The findings showed promise, with digital health technologies helping reduce alcohol and tobacco use. However, results for other substances and mental health outcomes, such as post-traumatic stress disorder and quality of life, were mixed. Importantly, few studies focused on women, and those that did often lacked diverse and representative samples. This lack of focus limits our understanding of how well these interventions work for women in such demanding roles. We highlight the urgent need for future research that addresses these gaps by prioritising larger, more inclusive studies. Tailoring digital tools to meet the unique challenges faced by women in frontline occupations can ensure these interventions are both effective and accessible, offering much-needed support in managing substance use.