Measuring the effects on quality of life and alcohol consumption of a program to reduce binge drinking in Spanish adolescents

A systematic review of health state utility values and psychometric performance of generic preference-based instruments for children and adolescents with mental health problems

AIMS

This paper aims to systematically identify reported health state utility values (HSUVs) in children and adolescents with mental health problems (MHPs) aged less than 25 years; to summarise the techniques used to elicit HSUVs; and to examine the psychometric performance of the identified multi-attribute utility instruments (MAUIs) used in this space.

METHODS

A systematic review was conducted following PRISMA guidelines. Peer-reviewed studies published in English, reporting HSUVs for children and adolescents with MHPs using direct or indirect valuation methods were searched in six databases.

RESULTS

We found 38 studies reporting HSUVs for 12 types of MHPs across 12 countries between 2005 and October 2021. Attention deficit hyperactivity disorder (ADHD) and depression are the most explored MHPs. Disruptive Behaviour Disorder was associated with the lowest reported HSUVs of 0.06 while cannabis use disorder was associated with the highest HSUVs of 0.88. Indirect valuation method through the use of MAUIs (95% of included studies) was the most frequently used approach, while direct valuation methods (Standard Gamble, Time Trade-Off) were only used to derive HSUVs in ADHD. This review found limited evidence of the psychometric performance of MAUIs used in children and adolescents with MHPs.

CONCLUSION

This review provides an overview of HSUVs of various MHPs, the current practice to generate HSUVs, and the psychometric performance of MAUIs used in children and adolescents with MHPs. It highlights the need for more rigorous and extensive psychometric assessments to produce evidence on the suitability of MAUIs used in this area.

Association between healthy lifestyle factors and health-related quality of life among Chinese adolescents: the moderating role of gender

BACKGROUND

To examine the associations of the independent and combined healthy lifestyle factors with health-related quality of life (HRQOL) in adolescents, and to test the moderating role of gender.

METHODS

This cross-sectional study included 5125 adolescents aged between 11 and 20 years. They provided self-reported data on six healthy lifestyle factors, including never smoking, never drinking, good sleep quality, sufficient sleep duration, appropriate Internet use, and adequate physical activity. Adolescents' HRQOL was evaluated using the Pediatric Quality of Life Inventory version 4.0. Linear regression models were conducted to explore the association of individual and combined healthy lifestyle factors with adolescents' HRQOL. We further performed stratified analyses and likelihood ratio test to explore the moderating role of gender in these associations.

RESULTS

Of the included adolescents, the proportions with 0-2, 3, 4, and 5-6 healthy lifestyle factors were 13.6%, 26.4%, 44.3%, and 15.7%, respectively. Compared to adolescents with composite healthy lifestyle scores of 0-2, those with scores of 3, 4, or 5-6 had significantly higher HRQOL scores across all dimensions, summary scales, and total scale in both unadjusted and adjusted models. Specifically, adolescents with 5-6 healthy lifestyle factors had a total scale score that was 19.03 (95%CI: 17.76 to 20.30) points higher than their counterparts who only had 0-2 healthy lifestyle factors. Significant dose-response patterns were also observed in aforementioned associations. Gender was a significant moderator in the associations between composite healthy lifestyle groups and HRQOL scores, except for the social functioning dimension.

CONCLUSIONS

Our results confirmed that combined healthy lifestyle factors were associated with improved HRQOL among adolescents, with a stronger association observed in girls. These findings underscore the necessity for education and healthcare authorities to design health-promoting strategies that encourage multiple healthy lifestyle factors in adolescents, with the objective of enhancing their overall health outcomes.

Digital interventions for substance use disorders in young people: rapid review

BACKGROUND

Young people are disproportionately more likely than other age groups to use substances. The rise in substance use and related harms, including overdose, during the Covid-19 pandemic has created a critical need for more innovative and accessible substance use interventions. Digital interventions have shown effectiveness and can provide more engaging, less stigmatizing, and accessible interventions that meet the needs of young people. This review provides an overview of recent literature on the nature of recently published digital interventions for young people in terms of technologies used, substances targeted, intended outcomes and theoretical or therapeutic models employed.

METHODS

Rapid review methodology was used to identify and assess the literature on digital interventions for young people. An initial keyword search was conducted using MEDLINE the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA) and PROSPERO for the years 2015-2020, and later updated to December 2021. Following a title/abstract and full-text screening of articles, and consensus decision on study inclusion, the data extraction process proceeded using an extraction grid developed for the study. Data synthesis relied on an adapted conceptual framework by Stockings, et al. that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment) for any type of substance.

RESULTS

In total, the review identified 43 articles describing 39 different digital interventions. Most were early interventions (n = 28), followed by prevention interventions (n = 6) and treatment interventions (n = 5). The identified digital technologies included web-based (n = 14), game-based (n = 10), mobile-based (n = 7), and computer-based (n = 5) technologies, and virtual reality (n = 3). Most interventions targeted alcohol use (n = 20) followed by tobacco/nicotine (n = 5), cannabis (n = 2), opioids (n = 2), ketamine (1) and multiple, or any substances (n = 9). Most interventions used a personalized or normative feedback approach and aimed to effect behaviour change as the intended outcome. Interestingly, a harm reduction approach guided only one of the 39 interventions.

CONCLUSIONS

While web-based interventions represented the most common type of technology, more recently developed immersive and interactive technologies such as virtual reality and game-based interventions call for further exploration. Digital interventions focused mainly on alcohol use, reflecting less concern for tobacco, cannabis, co-occurring substance use, and illicit drug use. Specifically, the recent exacerbation in the opioid crisis throughout North American underlines the urgent need for more prevention-oriented digital interventions for opioid use. The uptake of digital interventions among youth also depends on the incorporation of harm reduction approaches.

Cost-effectiveness and cost-utility analyses of a web-based computer-tailored intervention for prevention of binge drinking among Spanish adolescents

BACKGROUND

Binge drinking (BD) among adolescents is a public health concern worldwide. This study assessed the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence.

METHODS

The sample was drawn from a study evaluating the Alerta Alcohol program. The population consisted of adolescents 15 to 19 years of age. Data were recorded at baseline (January to February 2016) and after 4 months (May to June 2017) and were used to estimate costs and health outcomes, as measured by the number of BD occasions and quality-adjusted life years (QALYs). Incremental cost-effectiveness and cost-utility ratios were calculated from National Health Service (NHS) and societal perspectives and for a time horizon of 4 months. A multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty.

RESULTS

The cost of reducing BD occasions by one per month was €16.63 from the NHS perspective, which from the societal perspective resulted in savings of €7986.37. From the societal perspective, the intervention resulted in an incremental cost of €71.05 per QALY gained from the NHS perspective and this was dominant, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention was dominant for girls from both the perspectives and for individuals 17 years or older from the NHS perspective.

CONCLUSIONS

Computer-tailored feedback is a cost-effective way to reduce BD and increase QALYs among adolescents. However, long-term follow-up is needed to evaluate more fully changes in both BD and health-related quality of life.

Efficacy of theory-based interventions aimed at reducing binge drinking in adolescents: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND AND AIMS

Binge drinking is a widespread practice among adolescents worldwide and is associated with various harmful consequences. Theory-based interventions are a promising approach to prevent this drinking behaviour in this population. The aim of the present review was to determine: (1) the characteristics of theory-based interventions targeting binge drinking in adolescents, (2) the impact of such interventions on binge drinking, and (3) the quality of theoretical implementation.

METHODS

For this systematic review, randomised controlled trials were eligible for inclusion if the binge drinking-targeting intervention was based at least on one theoretical framework, and if the population's mean age was between 10 and 18 years. Two authors extracted relevant data. A meta-analysis was conducted to evaluate the effect of interventions on binge drinking. Effect sizes were calculated with the Hedges's g. Binge drinking was measured as a continuous or dichotomous outcome. The quality of theoretical implementation of interventions was measured using an existing "theory coding scheme".

RESULTS

Sixteen studies were identified. Ten were based on a single theory, and six on a combination of theories. The number and type of behaviour change techniques used in each intervention varied greatly. Theory-based interventions led to a small but significant decrease in binge drinking (Hedges's g = 0.10; 95% confidence interval = 0.04, 0.16). The quality of theoretical implementation was globally low, and the reciprocal link between behaviour change techniques and theoretical constructs was unclear for most studies.

CONCLUSIONS

Theory-based interventions have a small but significant beneficial impact on decreasing binge drinking in adolescents. Future research should try to be more effective in matching theoretical determinants of behaviour with the content of the intervention.

An Animation- Versus Text-Based Computer-Tailored Game Intervention to Prevent Alcohol Consumption and Binge Drinking in Adolescents: Study Protocol

The purpose of this paper is to describe the protocol for the design, implementation, and evaluation of an animation- versus text-based computer tailoring game intervention aimed at preventing alcohol consumption and binge drinking (BD) in adolescents. A cluster-randomized controlled trial (CRCT) is carried out in students aged 14-19 enrolled in 24 high schools from Andalusia (Spain), which are randomized either to experimental (EC-1, EC-2) or waiting-list control conditions (CC). EC-1 receives an online intervention (Alerta Alcohol) with personalized health advice, using textual feedback and several gamification techniques. EC-2 receives an improved version (Alerta Alcohol 2.0) using animated videos and new gamification strategies. Both programs consist of nine sessions (seven taking place at high school and two at home): session 1 or baseline, sessions 2 and 3 that provide tailored advice based on the I-Change Model; sessions 4, 5, 7, and 8 are booster sessions, and sessions 6 and 9 are follow-up questionnaires at six and twelve months. The CC completes the baseline and the evaluation questionnaires. The primary outcome is BD within 30 days before post-test evaluations, and as secondary outcomes we assess other patterns of alcohol use. The findings should help the development of future alcohol drinking prevention interventions in adolescents.