Psychosocial determinants of perceived vulnerability to harm among adult drinkers

Experience-Induced Change of Alcohol-Related Risk Perception in Patients with Alcohol Use Disorders

The role of alcohol-related risk perception for effective treatment of alcohol use disorders (AUD) is still unclear. The present study on 101 alcohol-dependent patients undergoing a 10-week AUD treatment protocol investigated the relationship between alcohol-related risk perception and alcohol use with the hypotheses that (1) risk perception changes across treatment, (2) changes vary with treatment-related experiences of abstinence/relapse indicating ‘risk reappraisal,’ and (3) adjustment of perceived own vulnerability according to ‘risk reappraisal hypothesis’ predicts abstinence during follow-up. Abstinence during treatment was related to a decrease, and relapse during treatment to a slight increase in perceived own risks. Abstinence during the 3-month follow-up varied with experience-induced risk reappraisal. The results show an impact of risk reappraisal on alcohol use and hence advocate a focus on risk reappraisal in AUD treatment.

Risikowahrnehmung und Alkoholabhängigkeit

Zusammenfassung. Zielsetzung: Alkoholabhängige Personen (AP) zeigen riskanten Alkoholkonsum trotz des Wissens um dessen objektive Risiken. Um die Bedeutung des Konstrukts Risikowahrnehmung für diese Diskrepanz zu überprüfen, wurde die „accuracy“ Hypothese und der „optimistic bias“ bei Alkoholabhängigkeit untersucht. Methodik: Zur Hypothesenprüfung wurden vier Dimensionen alkoholbezogener Risikowahrnehmung bei 73 stationär behandelten AP und 75 Kontrollpersonen (KP) anhand eines neu entwickelten deutschsprachigen Fragebogens verglichen und mit Alkoholkonsum in Beziehung gesetzt. Ergebnisse: AP schätzten im Vergleich zu KP eigene Risiken als höher ein und bewerteten diese als bedrohlicher. Trotz realistischer Wahrnehmung tendierten sie zu optimistischer Unterschätzung der eigenen Risiken. Wahrgenommene Vulnerabilität und Peer Vulnerabilität klärten neben der Diagnose Varianz im Konsum (AP: vor Behandlungsbeginn) auf. Der positive Zusammenhang zwischen Konsumverhalten und affektiver Bewertung von Risiken zeigte sich nur bei AP. Schlussfolgerungen: Die „accuracy“ Hypothese wurde bestätigt und konnte die realistische Wahrnehmung der Alkoholrisiken bei AP erklären. Gleichzeitig zeigten AP einen „optimistic bias“, welcher zu fortdauernd riskantem Trinken beitragen könnte. Das Konstrukt Risikowahrnehmung bietet Hypothesen für längsschnittliche Therapiestudien an, durch die weiterer Erkenntnisgewinn zu erwarten ist.

Assessing the immediate impact of normative drinking information using an immediate post-test randomized controlled design: implications for normative feedback interventions?

One alternative explanation for the observed impact of normative feedback interventions is that participants who receive normative information will just report reductions in their drinking rather than actually reducing the amount they drink. The current study tested the immediate impact of receiving normative information on self-reports of drinking.

METHODS

A random half of participants (39 out of 80) were presented with normative information about college drinking and then asked information about their drinking. Participants in the control condition were not presented with the normative information before answering the questions about their drinking.

RESULTS

Risky drinking participants presented with the normative information reported significantly less drinking as compared to those in the control condition (p<.05).

Short-term outcomes of a motivation-enhancing approach to DUI intervention

OBJECTIVE

We compared a group-delivered, theory-based, motivation-enhancing program (PRIME For Life(®) - PFL, n=450) to an intervention as usual (IAU, n=72).

METHOD

Individuals convicted of a substance related offense in North Carolina, typically first offense alcohol and drug-impaired driving, participated in a PFL or IAU group. We compare the interventions on program satisfaction and changes made from preintervention to postintervention, and examined the moderating effects of demographics and alcohol dependence level.

RESULTS

When significant, findings varied in magnitude from small to medium effects. Participants in both interventions showed intentions to use statistically significantly less alcohol and drugs in the future compared to their previous use, and differences between the groups were not statistically significant. Otherwise, findings favored PFL. PFL exhibited greater benefit than IAU on understanding tolerance, perceived risk for addiction, problem recognition, and program satisfaction. Additionally, IAU perceived less risk for negative consequences postintervention than they had at preintervention. Moderation analyses showed that the between-condition findings occurred regardless of gender, age, education, and number of alcohol dependence indicators. Additionally, younger people and those with more dependence indicators - groups of particular concern - showed the greatest change.

CONCLUSIONS

Findings suggest that a motivation-enhancing approach can be effective in producing short-term change in factors that can help facilitate and sustain behavioral change. This is consistent with previous research on the use of motivational approaches, and extends such findings to suggest promise in group-based settings and with people across demographic categories and dependence levels. Future research should focus on larger studies looking at long-term behavioral change, including recidivism.

Who uses online interventions for problem drinkers?

The goal of this research was to understand why some people use online interventions for drinking problems, whereas others with comparable access to the interventions do not. As part of a randomized controlled trial, 92 participants in the experimental condition were provided access to a password-protected version of a Web-based personalized feedback intervention (the Check Your Drinking [CYD] screener, www.CheckYourDrinking.net). Information collected at baseline was compared between those who accessed the Web site and those who did not. Those who accessed the Web site tended to be more frequent users of the Internet, to drink less, and to perceive that others of the same age and gender drank less as compared with those who did not access the intervention. Some of these results are troubling as the preferred target of this type of intervention would be those who drink more and perceive that others are also heavy alcohol consumers.

Ultra-brief intervention for problem drinkers: research protocol

BACKGROUND

Helping the large number of problem drinkers who will never seek treatment is a challenging issue. Public health initiatives employing educational materials or mass media campaigns have met with mixed success. However, clinical research has developed effective brief interventions to help problem drinkers. This project will employ an intervention that has been validated in clinical settings and then modified into an ultra-brief format suitable for use as a public health intervention. The major objective of this study is to conduct a randomized controlled trial to establish the effectiveness of an ultra-brief, personalized feedback intervention for problem drinkers.

METHODS/DESIGN

Problem drinkers recruited on a baseline population telephone survey conducted in a major metropolitan city in Canada will be randomized to one of three conditions - a personalized feedback pamphlet condition, a control pamphlet condition, or a no intervention control condition. In the week after the baseline survey, households in the two pamphlet conditions will be sent their respective pamphlets. Changes in drinking will be assessed post intervention at three-month and six-month follow-ups. Drinking outcomes will be compared between experimental conditions using Structural Equation Modeling. The primary hypothesis is that problem drinkers from households who receive the personalized feedback pamphlet intervention will display significantly improved drinking outcomes at three and six-month follow-ups as compared to problem drinkers from households in the no intervention control condition. Secondary hypotheses will test the impact of the intervention on help seeking, and explore the mediating or moderating role of perceived drinking norms, perceived alcohol risks and the problem drinker's social reasons for drinking.

DISCUSSION

This trial will provide information on the effectiveness of a pamphlet-based personalized feedback intervention for problem drinkers in a community setting.

TRIAL REGISTRATION

ClinicalTrials.gov registration #NCT00688584.

Predictors of perceived susceptibility of breast cancer and changes over time: a mixed modeling approach

OBJECTIVE

To examine predictors of perceived susceptibility to breast cancer and assess differences across three dependent measures.

DESIGN

Annual surveys were completed by US women veterans (N = 3,758) participating in a repeat mammography intervention trial. Multivariable non-linear mixed model analyses examined individual- and group-level changes in perceived susceptibility to breast cancer.

DEPENDENT MEASURES

Three single-item measures of perceived susceptibility to breast cancer (percent risk, ordinal risk, and comparative risk likelihood). Predictors included demographic, health status, health behavior, affect, knowledge, and subjective norm variables.

RESULTS

Breast symptoms and greater cancer worry increased perceived susceptibility for all three measures. Other predictors varied by dependent measure. Random change, indicating individual variability, was observed for percent risk only.

CONCLUSION

Despite small model effect sizes, breast symptoms and cancer worry were consistent predictors and may be good targets for messages designed to influence women's perceived susceptibility to breast cancer. Researchers may benefit from using measures of perceived susceptibility with larger response scales, but additional measurement research is needed. Combining indicators of perceived susceptibility may be undesirable when different predictors are associated with different measures.

Risk perceptions and worry about cancer: does gender make a difference?

Risk perceptions and worry are important constructs in many theoretical frameworks used to develop cancer screening interventions. Because most cancers for which we have early detection or prevention strategies are gender specific, few investigations have examined gender differences. We examined gender differences in the magnitude of, and associations with, perceived risk and worry by cancer type. Our sample included 939 men and 1,580 women >or= 50 years old with no history of relevant cancers from the 2003 Health Information National Trends Survey (HINTS). Dependent variables included absolute and comparative perceived risk and worry for gender-specific (breast/prostate) and colon cancers. We examined demographics, health status, health behaviors, cancer beliefs, and cancer communication variables as correlates. Linear regression analyses and pairwise contrasts were conducted with SUDAAN. Men reported greater comparative perceived risk for developing cancers, whereas women reported more frequent cancer worry. For both genders, perceived risk and worry were lowest for colon cancer. Correlates of perceived risk and worry varied, and several associations were moderated by gender. Different risk messages and intervention strategies may be needed to influence males' and females' perceived cancer risk and worry. All effect sizes were small, and future prospective research is needed to confirm our findings.

Increasing perceived choice about change in smokers: implications

Using a representative sample of 434 daily smokers, this study tested the immediate impact of providing "safer smoking tips". As was predicted, a randomized half of respondents who were asked about their knowledge of "safer smoking tips" before being asked about their perceptions of choice about smoking rated their perceived choice as higher than respondents who were not asked the safer smoking tips first. However, the present study also provided evidence of the need for caution because hearing about safer smoking tips was associated with lower ratings of perceptions of health risks from smoking. Perceived choice has been identified as an important factor in change from negative health behaviors, and the implications and future directions of this research are discussed.

Controlled study of brief personalized assessment-feedback for drinkers interested in self-help

AIMS

Brief alcohol interventions typically have been directed to heavy-drinking patients seeking primary health care and college students. This study examined the efficacy of mailing brief personalized assessment-feedback to interested drinkers recruited from the general public. We hypothesized that problem drinkers would benefit more from the intervention than individuals who were not problem drinkers.

DESIGN

A two-arm, double-blinded, community-based randomized controlled trial with 6-month follow-up.

SETTING AND PARTICIPANTS

A screening interview was administered to a stratified random sample of 10 014 Canadians 18 years of age and older (5621 women and 4393 men; M age = 43.3 years, SD = 15.99; response rate = 65.4%).

INTERVENTION

Current drinkers interested in receiving alcohol self-help materials (n = 1727) were assigned randomly to receive brief personalized assessment-feedback on male and female population drinking norms by mail, or to a delayed-treatment control group, and were contacted 6 months later (76% retention rate).

MEASUREMENTS

Problem drinking status at baseline [using sex-specific Alcohol Use Disorders Identification Test (AUDIT) cut scores], and frequency and quantity of alcohol use at follow-up.

FINDINGS

Analysis of covariance identified the hypothesized interaction of baseline problem drinking status and treatment condition (P < 0.01). Among problem drinkers identified at baseline the intervention caused a 10.1% reduction in per-occasion binge drinking compared to controls, whereas there was no difference in binge drinking across conditions for non-problem drinkers.

CONCLUSIONS

The continuum of care for alcohol problems can be broadened by providing brief interventions to interested drinkers in the general population.

Alcohol problems and interest in self-help: a population study of Alberta adults

BACKGROUND

We quantified the prevalence of alcohol problems among Alberta adults and determined relationships between sociodemographic characteristics, problem drinking status, and interest in self-help materials to reduce alcohol use.

METHODS

A computer-aided telephone interview was administered to a stratified random sample of 10,014 Albertans, 18 years of age or older (5,621 women and 4,393 men; M age = 43.3 years, SD = 16.0), with a response rate of 65.4%. Measures included: 1) current drinking status, 2) prior alcohol treatment, 3) problem drinking status (using the Alcohol Use Disorders Identification Test; AUDIT), and 4) interest in receiving free self-help materials to encourage safe drinking. Data were weighted to reflect age, sex, and regional Alberta population.

RESULTS

Of the total sample, 19.3% abstained from drinking in the past year, 4.2% had received treatment for alcohol problems at some point in their lives, and 80.7% were current drinkers (i.e., consumed alcohol in the previous year). Some 15.2% (n = 1,193) of current drinkers were classified as having a drinking problem. Logistic regression analyses showed that problem drinkers had 3.5 times greater odds of being male and 2.3 times greater odds of being interested in self-help interventions, compared to other current drinkers. Being single, of younger age, and not being exposed to post-secondary education also significantly predicted problem drinking status.

INTERPRETATION

Alcohol misuse is common among Alberta drinkers, but many of them are interested in receiving brief public health interventions designed to help them assert control over their behaviour.