Conducting intervention research among underserved populations: lessons learned and recommendations for researchers

Pressure Injury Data Reconciliation in a Randomized Controlled Trial

OBJECTIVE

To advance pressure injury (PrI) research in individuals with spinal cord injury (SCI) by describing lessons learned and recommendations for future research, ultimately promoting PrI prevention and more effective wound care. This paper describes the detailed procedures undertaken to collect and reconcile PrI data and summarizes the types of discrepancies identified.

DESIGN

Secondary analyses of PrI data collected between 2009 and 2014 in a randomized controlled trial (parent study).

SETTING

Participants in the parent study were recruited from a large rehabilitation center in the Los Angeles area that serves primarily individuals with limited resources.

PARTICIPANTS

232 participants with SCI and a history of 1 or more medically serious PrI (MSPrI) in the previous 5 years.

INTERVENTIONS

Participants in the parent study were randomized to a 12-month PrI prevention intervention led by an occupational therapist, or to usual care.

MAIN OUTCOME MEASURES

Relations among PrI characteristics, data sources (phone interviews, skin checks, paper and electronic medical records [MRs]), and treatment condition, and sensitivity of 6 different data sources in detecting MSPrIs.

RESULTS

The majority (62%) of MSPrIs were in the pelvic region. MRs detected 82% of the MSPrIs overall, making it the most sensitive data source, and scheduled skin checks were the second-most sensitive data source, finding 37% of the MSPrIs.

CONCLUSIONS

MR review is the preferred method for ascertaining MSPrIs in clinical trials of interventions designed to reduce the incidence of these injuries. When multiple sources of information are used, careful reconciliation of reports is necessary to ensure accuracy.

The efficacy of tobacco cessation treatment for African American adults: a systematic review

Despite proliferation of evidence-based tobacco cessation treatments, African American adults still suffer higher rates of tobacco-related diseases than White adults. Although tobacco cessation treatment is efficacious, there is a need to reassess the efficacy of tobacco cessation treatment for African American adults. Previous reviews of tobacco cessation treatment studies conducted through 2007 among African American adults highlight the limited research in this area and inconsistent findings on treatment characteristics impacting efficacy. This systematic review examined the efficacy of combined behavioral and pharmacological tobacco cessation treatment for African American adults. Database searches were used to identify studies examining tobacco cessation treatment for predominantly African American samples (>50%). Eligible studies were completed between 2007 and 2021 and (i) involved randomization comparing active combined treatment to a control comparison group and (ii) reported abstinence outcomes at 6 and/or 12 months. Ten studies met inclusion criteria. Active treatment groups typically consisted of a combination of nicotine replacement therapy and behavioral counseling. Abstinence rates for African American adults ranged from 10.0% to 34% in active treatment groups compared to 0.0%-40% in comparison control groups. Our results support the efficacy of combined treatment for tobacco cessation among African American adults. However, cessation rates for African American adults found in this review are lower than those in the general adult population (15%-88%). Additionally, our findings highlight the limited number of studies examining African American tobacco cessation rates and testing of tailored treatment for this population.

Feasibility of Problem Adaption Therapy in a Diverse, Frail Older Adult Population (PATH-MHS)

The purpose of the Problem Adaptation Therapy - Montefiore Health System (PATH-MHS) pilot program was to demonstrate the feasibility and effectiveness of PATH across a culturally, educationally, and functionally diverse cohort of older adults.

METHODS

Clinicians referred 145 participants with depression and cognitive impairment to PATH-MHS. We completed analyses of the change in depression, disability and the association between baseline characteristics and remission of depression.

RESULTS

Most participants were Hispanic or Non-Hispanic Black and 54.7% (76) were primary Spanish speakers. Overall, there were significant decreases in the mean PHQ-9 and WHODAS 2.0 scores. In logistic regression models, neither age, education, gender, race/ethnicity, language nor long-term care status was significantly associated with remission of depression.

CONCLUSIONS

This study demonstrates that we were able to engage a diverse, cognitively impaired, and frail cohort of older adults in PATH-MHS with significant reductions in depression and disability.

Project SUN: Pilot Study of a Culturally Adapted Smoking Cessation Curriculum for American Indian Youth

American Indian Alaska Native (AIAN) youth have disproportionately higher rates of commercial tobacco product use compared to other racial and ethnic groups in the U.S. These rates underscore a need for commercial tobacco product cessation interventions that are culturally informed. This project studied the development, implementation, and some impact data of an adapted version of Project EX, an evidence-based intervention for teen smoking cessation. Implementation challenges resulted in a change from a three-arm to a single-arm trial with 37 AIAN youth who participated in an eight-week curriculum. Intent-to-treat analysis with biochemical validation results indicated that 32% (N = 12/37) of youth quit smoking at the three-month follow-up. Participants reported being satisfied with the program overall and enjoying the culturally adapted activities. This study detailed the program's adaptation and lessons learned during implementation.

Reactive Oxygen Species and Pressure Ulcer Formation after Traumatic Injury to Spinal Cord and Brain

Traumatic injuries to the nervous system, including the brain and spinal cord, lead to neurological dysfunction depending upon the severity of the injury. Due to the loss of motor (immobility) and sensory function (lack of sensation), spinal cord injury (SCI) and brain injury (TBI) patients may be bed-ridden and immobile for a very long-time. These conditions lead to secondary complications such as bladder/bowel dysfunction, the formation of pressure ulcers (PUs), bacterial infections, etc. PUs are chronic wounds that fail to heal or heal very slowly, may require multiple treatment modalities, and pose a risk to develop further complications, such as sepsis and amputation. This review discusses the role of oxidative stress and reactive oxygen species (ROS) in the formation of PUs in patients with TBI and SCI. Decades of research suggest that ROS may be key players in mediating the formation of PUs. ROS levels are increased due to the accumulation of activated macrophages and neutrophils. Excessive ROS production from these cells overwhelms intrinsic antioxidant mechanisms. While short-term and moderate increases in ROS regulate signal transduction of various bioactive molecules; long-term and excessively elevated ROS can cause secondary tissue damage and further debilitating complications. This review discusses the role of ROS in PU development after SCI and TBI. We also review the completed and ongoing clinical trials in the management of PUs after SCI and TBI using different technologies and treatments, including antioxidants.

The equity paradox: older patients' participation in patient portal development

PURPOSE

This paper reflects on ethical concerns to patient portals design and evaluation approaches and provides a comprehensive overview of methodological considerations to advance patient participation of older patients to patient portal research and development.

REFLECTION

Barriers to the use of current patient portals experienced by older patients are concentrated on access issues and difficulties with interpretation of medical content. As patient portals' functionalities are being expanded by means of co-creation and user-testing such barriers often remain unrecognized. A main challenge of these patient participation efforts is namely to include a variety of older patients; foremost autonomous patients seem to participate. By selecting autonomous participants in co-creation or user-testing, design solutions are proposed that specifically benefit the autonomy of that patient, whereas it does not do justice to values and interests of patients who are less independent and are confronted with a wider variety of use barriers. Consequently, there is a risk of widening the gap between those who can use and benefit from patient portals and those who cannot. To prevent this from happening, we propose three main methodological aspects to consider in co-creation and user-testing activities that aim to optimize patient portal functionalities.

IMPLICATIONS

We encourage policy makers and patient portal developers to use present-day's momentum to include older patients' abilities, needs and context in the decision-making and investments in further advancing patient portals. We further stimulate future research that aims to improve methods to overcome challenges of older patients' participation regarding design and evaluation of eHealth systems.

The cognitive and psychological effects of living with type 1 diabetes: a narrative review

Across the lifespan, type 1 diabetes mellitus has a profound (neuro)psychological impact. In young people, type 1 diabetes can interfere with psychosocial development and hamper school performance. In adulthood, it can interfere with work life, relationships and parenting. A substantial minority of adults with type 1 diabetes experience coping difficulties and high diabetes-related distress. In youth and adulthood, type 1 diabetes is related to mild cognitive decrements as well as affective disorders, such as depression and anxiety. There is limited literature available that explores the interaction between cognitive and psychological comorbidity and underlying mechanisms. The aims of the present narrative review were to summarize the current state of the literature regarding both cognitive and psychological comorbidities in type 1 diabetes across the lifespan, and to explore potential links between the two domains of interest to make suggestions for future research and clinical practice.

Effects of a parenting sexual education program for immigrant parents: A cluster randomized trial

OBJECTIVES

The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents.

METHODS

A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants' knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention.

RESULTS

After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of <14.62, <110.27, and <41.5, respectively.

CONCLUSIONS

An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents.

PRACTICE IMPLICATIONS

In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age.

Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study

CONTEXT/OBJECTIVE

Medically serious pressure injuries (MSPrIs), a common complication of spinal cord injury (SCI), have devastating consequences on health and well-being and are extremely expensive to treat. We aimed to test the efficacy of a lifestyle-based intervention designed to reduce incidence of MSPrIs in adults with SCI.

DESIGN

A randomized controlled trial (RCT), and a separate study wing involving a nonrandomized standard care control group.

SETTING

Rancho Los Amigos National Rehabilitation Center, a large facility serving ethnically diverse, low income residents of Los Angeles County.

PARTICIPANTS

Adults with SCI, with history of one or more MSPrIs over the past 5 years: N=166 for RCT component, N=66 in nonrandomized control group.

INTERVENTIONS

The Pressure Ulcer Prevention Program, a 12-month lifestyle-based treatment administered by healthcare professionals, largely via in-home visits and phone contacts.

OUTCOME MEASURES

Blinded assessments of annualized MSPrI incidence rates at 12 and 24 months, based on: skin checks, quarterly phone interviews with participants, and review of medical charts and billing records. Secondary outcomes included number of surgeries and various quality-of-life measures.

RESULTS

Annualized MSPrI rates did not differ significantly between study groups. At 12 months, rates were .56 for intervention recipients, .48 for randomized controls, and .65 for nonrandomized controls. At follow-up, rates were .44 and .39 respectively for randomized intervention and control participants.

CONCLUSIONS

Evidence for intervention efficacy was inconclusive. The intractable nature of MSPrI threat in high-risk SCI populations, and lack of statistical power, may have contributed to this inability to detect an effect.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01999816.

The Methodological Quality and Effectiveness of Technology-Based Smoking Cessation Interventions for Disadvantaged Groups: A Systematic Review and Meta-analysis

Aims

To assess the methodological quality and effectiveness of technology-based smoking cessation interventions in disadvantaged groups.

Method

Four databases (EMBASE, Cochrane, Medline, and PsycInfo) were searched for studies conducted from 1980 to May 2016. Randomized controlled trials that compared a behavioral smoking cessation intervention delivered primarily through a technology-based platform (eg, mobile phone) with a no-intervention comparison group among disadvantaged smokers were included. Three reviewers assessed all relevant studies for inclusion, and one reviewer extracted study, participant and intervention-level data, with a subset crosschecked by a second reviewer.

Results

Thirteen studies targeting disadvantaged smokers (n =4820) were included. Only one study scored highly in terms of methodological rigor on EPOC criteria for judging risk of bias. Of the 13 studies using a technology-based platform, most utilized websites (n = 5) or computer programs (n = 5), and seven additionally offered nicotine replacement therapy. Technology-based interventions increased the odds of smoking cessation for disadvantaged groups at 1 month (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.10, 2.63), 3 months (OR 1.30, 95% CI 1.07, 1.59), 6 months (OR 1.29, 95% CI 1.03, 1.62), and 18 months post-intervention (OR 1.83, 95% CI 1.11, 3.01).

Conclusion

Few methodologically rigorous studies were identified. Mobile phone text-messaging, computer- and website-delivered quit support showed promise at increasing quit rates among Indigenous, psychiatric and inpatient substance use disorder patients. Further research is needed to address the role technology-based interventions have on overcoming health inequalities to meet the needs of disadvantaged groups.

Implications

This review provides the first quantitative evidence of the effectiveness of a range of technology-based smoking cessation interventions among disadvantaged smokers, with separate estimates on the basis of intervention type, and cessation outcome measure. Providing cost-effective, easily accessible and real-time smoking cessation treatment is needed, and innovative technology-based platforms will help reach this endpoint. These interventions need to be tested in larger scale randomized controlled trial designs and target broader disadvantaged groups. Data collection beyond 6 months is also needed in order to establish the efficacy of these intervention approaches on long-term cessation rates among disadvantaged population groups.

Lifestyle changes and pressure ulcer prevention in adults with spinal cord injury in the pressure ulcer prevention study lifestyle intervention

Pressure ulcers (PrUs) are a major burden to patients with spinal cord injury (SCI), affecting their psychological, physical, and social well-being. Lifestyle choices are thought to contribute to the risk of developing PrUs. This article focuses on the interaction between lifestyle choices and the development of PrUs in community settings among participants in the University of Southern California-Rancho Los Amigos National Rehabilitation Center Pressure Ulcer Prevention Study (PUPS II), a randomized controlled trial of a lifestyle intervention for adults with SCI. We conducted a secondary cross-case analysis of treatment notes of 47 PUPS II participants and identified four patterns relating PrU development to lifestyle changes: positive PrU changes (e.g., healing PrUs) with positive lifestyle changes, negative or no PrU changes with positive lifestyle changes, positive PrU changes with minor lifestyle changes, and negative or no PrU changes with no lifestyle changes. We present case studies exemplifying each pattern.

Smoking Cessation among Low-Socioeconomic Status and Disadvantaged Population Groups: A Systematic Review of Research Output

Background: Smoking cessation research output should move beyond descriptive research of the health problem to testing interventions that can provide causal data and effective evidence-based solutions. This review examined the number and type of published smoking cessation studies conducted in low-socioeconomic status (low-SES) and disadvantaged population groups. Methods: A systematic database search was conducted for two time periods: 2000–2004 (TP1) and 2008–2012 (TP2). Publications that examined smoking cessation in a low-SES or disadvantaged population were coded by: population of interest; study type (reviews, non-data based publications, data-based publications (descriptive, measurement and intervention research)); and country. Intervention studies were coded in accordance with the Cochrane Effective Practice and Organisation of Care data collection checklist and use of biochemical verification of self-reported abstinence was assessed. Results: 278 citations were included. Research output (i.e., all study types) had increased from TP1 27% to TP2 73% (χ² = 73.13, p < 0.001), however, the proportion of data-based research had not significantly increased from TP1 and TP2: descriptive (TP1 = 23% vs. TP2 = 33%) or intervention (TP1 = 77% vs. TP2 = 67%). The proportion of intervention studies adopting biochemical verification of self-reported abstinence had significantly decreased from TP1 to TP2 with an increased reliance on self-reported abstinence (TP1 = 12% vs. TP2 = 36%). Conclusions: The current research output is not ideal or optimal to decrease smoking rates. Research institutions, scholars and funding organisations should take heed to review findings when developing future research and policy.

An Exploratory Analysis of the Smoking and Physical Activity Outcomes From a Pilot Randomized Controlled Trial of an Exercise Assisted Reduction to Stop Smoking Intervention in Disadvantaged Groups

INTRODUCTION

Economically disadvantaged smokers not intending to stop may benefit from interventions aimed at reducing their smoking. This study assessed the effects of a behavioral intervention promoting an increase in physical activity versus usual care in a pilot randomized controlled trial.

METHODS

Disadvantaged smokers who wanted to reduce but not quit were randomized to either a counseling intervention of up to 12 weeks to support smoking reduction and increased physical activity (n = 49) or usual care (n = 50). Data at 16 weeks were collected for various smoking and physical activity outcomes. Primary analyses consisted of an intention to treat analysis based on complete case data. Secondary analyses explored the impact of handling missing data.

RESULTS

Compared with controls, intervention smokers were more likely to initiate a quit attempt (36 vs. 10%; odds ratio 5.05, [95% CI: 1.10; 23.15]), and a greater proportion achieved at least 50% reduction in cigarettes smoked (63 vs. 32%; 4.21 [1.32; 13.39]). Postquit abstinence measured by exhaled carbon monoxide at 4-week follow-up showed promising differences between groups (23% vs. 6%; 4.91 [0.80; 30.24]). No benefit of intervention on physical activity was found. Secondary analyses suggested that the standard missing data assumption of "missing" being equivalent to "smoking" may be conservative resulting in a reduced intervention effect.

CONCLUSIONS

A smoking reduction intervention for economically disadvantaged smokers which involved personal support to increase physical activity appears to be more effective than usual care in achieving reduction and may promote cessation. The effect does not appear to be influenced by an increase in physical activity.

Retaining traditionally hard to reach participants: Lessons learned from three childhood obesity studies

Retaining underserved populations, particularly low-income and/or minority participants in research trials, presents a unique set of challenges. In this paper, we describe the initial retention strategies and enhanced the retention strategies over time across three childhood obesity prevention trials. Hip-Hop to Health Jr. (HH) was a randomized controlled trial (RCT) testing a preschool-based obesity prevention intervention among predominately African-American children. Retention was 89% at 14-weeks, 71% at 1-year, and 73% at 2-year follow-up. Primary retention strategies for HH included: 1) collaboration with a community-based organization to enhance program credibility; 2) continuity of data collection locations; 3) collecting detailed contact information and provision of monetary compensation; and 4) developing a detailed tracking/search protocol. In a follow-up trial, Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial (HH Effectiveness), 95% of participants completed assessment at 14 weeks and 88% completed assessment at 1 year. For this trial, we emphasized staffing continuity in order to enhance participant relationship building and required data collection staff to have relevant community service experience. In a third study, we assessed dietary quality among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) across three time points following the WIC food package shift instituted nationally in 2009. Retention rates were 91% at 12 months and 89% at 18 months. For our WIC\ study, we augmented retention by developing a home data collection protocol and increased focus on staff diversity training. We conclude with a summary of key strategies and suggestions for future research.

A Conceptual Model to Promote the Retention of Women with Physical Disabilities in Research

Inadequate participant recruitment and retention practices can affect sample representativeness and thus the generalizability of research findings. Retention of research participants has been examined within the literature to some extent; however, there is no consensus on best practice in achieving acceptable results. Furthermore, there is a gap in understanding how to engage and retain women with physical disabilities (WPDs) in research. To address these oversights, we review (1) the significance of retention as a methodological concern, (2) factors that influence the involvement and retention of participants in research, including individual, population, and health-illness considerations, and (3) particular circumstances impacting the inclusion and retention of WPDs in research. On the basis of a review of the literature and our experience with the Healing Pathways randomized controlled trial (RCT), we present a conceptual model to guide culturally sensitive health research implementation with WPDs, and promote the engagement and retention of this group in RCTs and other forms of interventional health research.

Parent-based adolescent sexual health interventions and effect on communication outcomes: a systematic review and meta-analyses

CONTEXT

Parent-based adolescent sexual health interventions aim to reduce sexual risk behaviors by bolstering parental protective behaviors. Few studies of theory use, methods, applications, delivery and outcomes of parent-based interventions have been conducted.

METHODS

A systematic search of databases for the period 1998-2013 identified 28 published trials of U.S. parent-based interventions to examine theory use, setting, reach, delivery mode, dose and effects on parent-child communication. Established coding schemes were used to assess use of theory and describe methods employed to achieve behavioral change; intervention effects were explored in meta-analyses.

RESULTS

Most interventions were conducted with minority parents in group sessions or via self-paced activities; interventions averaged seven hours, and most used theory extensively. Meta-analyses found improvements in sexual health communication: Analysis of 11 controlled trials indicated a medium effect on increasing communication (Cohen's d, 0.5), and analysis of nine trials found a large effect on increasing parental comfort with communication (0.7); effects were positive regardless of delivery mode or intervention dose. Intervention participants were 68% more likely than controls to report increased communication and 75% more likely to report increased comfort.

CONCLUSIONS

These findings point to gaps in the range of programs examined in published trials-for example, interventions for parents of sexual minority youth, programs for custodial grandparents and faith-based services. Yet they provide support for the effectiveness of parent-based interventions in improving communication. Innovative delivery approaches could extend programs' reach, and further research on sexual health outcomes would facilitate the meta-analysis of intervention effectiveness in improving adolescent sexual health behaviors.

Building a framework for implementing new interventions

Implementation into real-world practice of interventions previously studied in randomized controlled trials is an ongoing challenge. In this article, we describe the methodology we used for the first phase of a project for the implementation and outcomes assessment of an occupational therapy pressure ulcer prevention intervention for people with spinal cord injury in the Veterans Health Administration. This first phase of the project was guided by practice-based evidence research methodology and resulted in an intervention manual tailored to meet the needs of Veterans and the establishment of a system for documenting and monitoring care processes, patient characteristics, and intervention outcomes. This system, in turn, will provide the data-gathering template for the next phase in which the beneficial effects of the intervention will be assessed. We conclude by recommending that clinicians explore the utility of this approach for the implementation of other novel interventions.

Implementing trials of complex interventions in community settings: the USC-Rancho Los Amigos pressure ulcer prevention study (PUPS)

BACKGROUND

Randomized trials of complex, non-pharmacologic interventions implemented in home and community settings, such as the University of Southern California (USC)-Rancho Los Amigos National Rehabilitation Center (RLANRC) Pressure Ulcer Prevention Study (PUPS), present unique challenges with respect to (1) participant recruitment and retention, (2) intervention delivery and fidelity, (3) randomization and assessment, and (4) potential inadvertent treatment effects.

PURPOSE

We describe the methods employed to address the challenges confronted in implementing PUPS. In this randomized controlled trial, we are assessing the efficacy of a complex, preventive intervention in reducing the incidence of, and costs associated with, the development of medically serious pressure ulcers in people with spinal cord injury.

METHODS

Individuals with spinal cord injury recruited from RLANRC were assigned to either a 12-month preventive intervention group or a standard care control group. The primary outcome is the incidence of serious pressure ulcers with secondary endpoints including ulcer-related surgeries, medical treatment costs, and quality of life. These outcomes are assessed at 12 and 24 months after randomization. Additionally, we are studying the mediating mechanisms that account for intervention outcomes.

RESULTS

PUPS has been successfully implemented, including recruitment of the target sample size of 170 participants, assurance of the integrity of intervention protocol delivery with an average 90% treatment adherence rate, and enactment of the assessment plan. However, implementation has been replete with challenges. To meet recruitment goals, we instituted a five-pronged approach customized for an underserved, ethnically diverse population. In intervention delivery, we increased staff time to overcome economic and cultural barriers to retention and adherence. To ensure treatment fidelity and replicability, we monitored intervention protocol delivery in accordance with a rigorous plan. Finally, we have overcome unanticipated assessment and design concerns related to (1) determining pressure ulcer incidence/severity, (2) randomization imbalance, and (3) inadvertent potential control group contamination.

LIMITATIONS

We have addressed the most daunting challenges encountered in the recruitment, assessment, and intervention phases of PUPS. Some challenges and solutions may not apply to trials conducted in other settings.

CONCLUSIONS

Overcoming challenges has required a multifaceted approach incorporating individualization, flexibility, and persistence, as well as the ability to implement needed mid-course corrections.

The effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among adolescents aged 15-20 years with a low educational background: a two-arm parallel group cluster randomized controlled trial

BACKGROUND

To evaluate the slightly modified version of the web-based brief alcohol intervention "What Do You Drink" (WDYD) among heavy drinking adolescents and young adults aged 15-20 years with a low educational background at one and six months follow-up.

METHODS

A two-arm parallel group cluster randomized controlled trial was conducted online in the Netherlands in 2011-2012. Participants included in the trial were recruited from preparatory and secondary vocational education institutions and had to be between 15 and 20 years of age and report heavy drinking in the past six months. In total, 73 classes representing 609 (59.9% male) participants were allocated to the experimental condition (37 classes, 318 participants: WDYD intervention) or control condition (36 classes, 291 participants: no intervention). Outcomes were heavy drinking, weekly alcohol consumption, and frequency of binge drinking.

RESULTS

Regressions analyses revealed no significant main intervention effects on any of the alcohol outcomes at one and six month's follow-up according to the intention-to-treat principle. Additionally, there were no moderating effects of gender, age, educational level, and readiness to change on the relation between the WDYD intervention and the alcohol outcomes at follow-up.

CONCLUSIONS

The WDYD intervention was not effective in reducing alcohol consumption among heavy drinking adolescents and young adults aged 15-20 years with a low educational background at one and six months follow-up. However, the absence of intervention effectiveness cannot be used as an argument for not conducting these types of interventions with low educated individuals, since our study was the first to target this population.

TRIAL REGISTRATION

Netherlands Trial Register NTR2971.