Desire to get drunk partially mediates effects of a combined text message-based alcohol intervention for young adults

A sex- and gender-based analysis of alcohol treatment intervention research involving youth: A methodological systematic review

BACKGROUND

While there is widespread consensus that sex- and gender-related factors are important for how interventions are designed, implemented, and evaluated, it is not currently known how alcohol treatment research accounts for sex characteristics and/or gender identities and modalities. This methodological systematic review documents and assesses how sex characteristics, gender identities, and gender modalities are operationalized in alcohol treatment intervention research involving youth.

METHODS AND FINDINGS

We searched MEDLINE, Embase, Cochrane Central Registry of Controlled Trials, PsycINFO, CINAHL, LGBT Life, Google Scholar, Web of Science, and grey literature from 2008 to 2023. We included articles that reported genders and/or sexes of participants 30 years of age and under and screened participants using AUDIT, AUDIT-C, or a structured interview using DSM-IV criteria. We limited the inclusion to studies that enrolled participants in alcohol treatment interventions and used a quantitative study design. We provide a narrative overview of the findings. Of 8,019 studies screened for inclusion, 86 articles were included in the review. None of the studies defined, measured, and reported both sex and gender variables accurately. Only 2 studies reported including trans participants. Most of the studies used gender or sex measures as a covariate to control for the effects of sex or gender on the intervention but did not discuss the rationale for or implications of this procedure.

CONCLUSIONS

Our findings identify that the majority of alcohol treatment intervention research with youth conflate sex and gender factors, including terminologically, conceptually, and methodologically. Based on these findings, we recommend future research in this area define and account for a spectrum of gender modalities, identities, and/or sex characteristics throughout the research life cycle, including during study design, data collection, data analysis, and reporting. It is also imperative that sex and gender variables are used expansively to ensure that intersex and trans youth are meaningfully integrated.

TRIAL REGISTRATION

Registration: PROSPERO, registration number: CRD42019119408.

Prediction Rules Identify Which Young Adults Have Higher Rates of Heavy Episodic Drinking After Exposure to 12-Week Text Message Interventions

BACKGROUND

An alcohol text message intervention recently demonstrated effects in reducing heavy episodic drinking (HED) days at the three month follow-up in young adults with a history of hazardous drinking. An important next step in understanding intervention effects involves identifying baseline participant characteristics that predict who will benefit from intervention exposure to support clinical decision-making and guide further intervention development. To identify baseline characteristics that predict HED, this exploratory study used a prediction rule ensemble (PRE). Compared to more complex decision-tree methods (e.g., random forest), PREs have comparable performance, while generating simpler rules that can directly identify subgroups that do or do not respond to intervention.

METHODS

This secondary analysis examined data from 916 young adults who reported HED (68.5% female, mean age = 22.1, SD = 2.1), were enrolled in an alcohol text message randomized clinical trial and who completed baseline assessment and the three month follow-up. A PRE with ten fold cross-validation, which included 21 baseline variables representing sociodemographic characteristics (e.g., sex, age, race, ethnicity, college enrollment), alcohol consumption (frequency of alcohol consumption, quantity consumed on a typical drinking day, frequency of HED), impulsivity subscales (i.e., negative urgency, positive urgency, lack of premeditation, lack of perseverance, sensation seeking), readiness to change, perceived peer drinking and HED-related consequences, and intervention status were used to predict HED at the three month follow-up.

RESULTS

The PRE identified 12 rules that predicted HED at three months (R2 = 0.23) using 7 baseline features. Only two cases (0.2%) were not classified by the 12 rules. The most important features for predicting three month HED included baseline alcohol consumption, negative urgency score, and perceived peer drinking.

CONCLUSIONS

The rules provide interpretable decision-making tools that predict who has higher alcohol consumption following exposure to alcohol text message interventions using baseline participant characteristics (prior to intervention), which highlight the importance of interventions related to negative urgency and peer alcohol use.

Effect of provision of non-alcoholic beverages on alcohol consumption: a randomized controlled study

BACKGROUND

The use of alcohol-flavored beverages not containing alcohol (hereinafter referred to as non-alcoholic beverages) is recommended to reduce alcohol consumption. However, it is unclear if this reduces excessive drinking.

OBJECTIVE

To verify whether non-alcoholic beverages impact the alcohol consumption of excessive drinkers.

STUDY DESIGN

Single-center, open-label, randomized, parallel-group study.

METHODS

Participants aged 20 years or older who were not diagnosed with alcoholism, who drank at least four times a week, and whose alcohol consumption on those days was at least 40 g in males and 20 g in females, were recruited. Participants were randomized into the intervention or control group by simple randomization using a random number table. In the intervention group, free non-alcoholic beverages were provided once every 4 weeks for 12 weeks (three times in total), and thereafter, the number of alcoholic and non-alcoholic beverages consumed were recorded for up to 20 weeks. The consumption of alcoholic and non-alcoholic beverages was calculated based on a drinking diary submitted with the previous 4 weeks of data. The primary endpoint was the change from baseline in total alcohol consumption during past 4 weeks at week 12. The participants were not blinded to group allocations.

RESULTS

Fifty-four participants (43.9%) were allocated to the intervention group and 69 (56.1%) to the control group. None of the participants in the intervention group dropped out, compared to two (1.6%) in the control group. The change in alcohol consumption was - 320.8 g (standard deviation [SD], 283.6) in the intervention group and - 76.9 g (SD, 272.6) in the control group at Week 12, indicating a significant difference (p < 0.001). Even at Week 20 (8 weeks after the completion of the intervention), the change was - 276.9 g (SD, 39.1) in the intervention group, which was significantly greater than - 126.1 g (SD, 41.3) in the control group (p < 0.001). The Spearman rank correlation coefficient between the change in non-alcoholic beverage consumption and alcohol consumption at Week 12 was significantly negative only in the intervention group (ρ =  - 0.500, p < 0.001). There were no reports of adverse events during the study.

CONCLUSIONS

Providing non-alcoholic beverages significantly reduced alcohol consumption, an effect that persisted for 8 weeks after the intervention.

TRIAL REGISTRATION

UMIN UMIN000047949. Registered 4 June 2022.