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Wood E, Pan J, Cui Z, Bach P, Dennis B, Nolan S, Socias ME. Does This Patient Have Alcohol Use Disorder?: The Rational Clinical Examination Systematic Review. JAMA 2024; 331:1215-1224. [PMID: 38592385 DOI: 10.1001/jama.2024.3101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Importance The accuracy of screening tests for alcohol use disorder (defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress) requires reassessment to align with the latest definition in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5). Objective To assess the diagnostic accuracy of screening tools in identifying individuals with alcohol use disorder as defined in the DSM-5. Data Sources and Study Selection The databases of MEDLINE and Embase were searched (January 2013-February 2023) for original studies on the diagnostic accuracy of brief screening tools to identify alcohol use disorder according to the DSM-5 definition. Because diagnosis of alcohol use disorder does not include excessive alcohol use as a criterion, studies of screening tools that identify excessive or high-risk drinking among younger (aged 9-18 years), older (aged ≥65 years), and pregnant persons also were retained. Data Extraction and Synthesis Sensitivity, specificity, and likelihood ratios (LRs) were calculated. When appropriate, a meta-analysis was performed to calculate a summary LR. Results Of 4303 identified studies, 35 were retained (N = 79 633). There were 11 691 individuals with alcohol use disorder or a history of excessive drinking. Across all age categories, a score of 8 or greater on the Alcohol Use Disorders Identification Test (AUDIT) increased the likelihood of alcohol use disorder (LR, 6.5 [95% CI, 3.9-11]). A positive screening result using AUDIT identified alcohol use disorder better among females (LR, 6.9 [95% CI, 3.9-12]) than among males (LR, 3.8 [95% CI, 2.6-5.5]) (P = .003). An AUDIT score of less than 8 reduced the likelihood of alcohol use disorder similarly for both males and females (LR, 0.33 [95% CI, 0.20-0.52]). The abbreviated AUDIT-Consumption (AUDIT-C) has sex-specific cutoff scores of 4 or greater for males and 3 or greater for females, but was less useful for identifying alcohol use disorder (males: LR, 1.8 [95% CI, 1.5-2.2]; females: LR, 2.0 [95% CI, 1.8-2.3]). The AUDIT-C appeared useful for identifying measures of excessive alcohol use in younger people (aged 9-18 years) and in those older than 60 years of age. For those younger than 18 years of age, the National Institute on Alcohol Abuse and Alcoholism age-specific drinking thresholds were helpful for assessing the likelihood of alcohol use disorder at the lowest risk threshold (LR, 0.15 [95% CI, 0.11-0.21]), at the moderate risk threshold (LR, 3.4 [95% CI, 2.8-4.1]), and at the highest risk threshold (LR, 15 [95% CI, 12-19]). Among persons who were pregnant and screened within 48 hours after delivery, an AUDIT score of 4 or greater identified those more likely to have alcohol use disorder (LR, 6.4 [95% CI, 5.1-8.0]), whereas scores of less than 2 for the Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down screening tool and the Tolerance, Annoyed, Cut-Down and Eye-Opener screening tool identified alcohol use disorder similarly (LR, 0.05 [95% CI, 0.01-0.20]). Conclusions and Relevance The AUDIT screening tool is useful to identify alcohol use disorder in adults and in individuals within 48 hours postpartum. The National Institute on Alcohol Abuse and Alcoholism youth screening tool is helpful to identify children and adolescents with alcohol use disorder. The AUDIT-C appears useful for identifying various measures of excessive alcohol use in young people and in older adults.
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Affiliation(s)
- Evan Wood
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jeffrey Pan
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Brittany Dennis
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Li L, Liu Y, Chen Z, Ren S, He R, Liang Y, Tan Y, Shao X, Chen S, Kong X, Tang J, Chen X, Liao Y. Gender differences in alcohol drinking among adolescents: a school-based survey in China. BMJ Open 2024; 14:e080687. [PMID: 38553083 PMCID: PMC10982719 DOI: 10.1136/bmjopen-2023-080687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Alcohol drinking among adolescents is associated with their health development. However, the prevalence of alcohol drinking among adolescents in Southwestern China remains largely unexplored. This study aimed to investigate the prevalence of alcohol drinking, with a particular focus on gender differences, among primary and middle school students in Zigong, a city in Southwestern China. Additionally, we examined the association between alcohol consumption and demographic and family factors. METHODS A school-based cross-sectional survey was conducted in a city in Southwestern China, encompassing a total of 89 360 students from 132 different ordinary schools, including both primary and middle schools. Participants were recruited through cluster sampling. The Alcohol Use Disorders Identification Test Consumption was employed to assess alcohol consumption. Gender differences in the prevalence of alcohol drinkers across various schools and grades were analysed. Multivariable logistic regression analysis was used to investigate factors associated with hazardous drinking. RESULTS Out of the 89 360 participants, 19.0% reported alcohol drinking, with 2.1% classified as hazardous drinkers. There was a higher prevalence of alcohol drinking among boys compared with girls, as well as hazardous drinking. There were significant gender disparities in alcohol drinking observed across various schools and grade levels. A notable divergence between boys and girls was observed starting from grade 10, with a rising prevalence of hazardous drinking among boys and a decline among girls. Additionally, older age, male gender and being left-behind children were identified as risk factors for hazardous drinking, while belonging to a nuclear family and having parents who do not drink were protective factors against hazardous drinking. CONCLUSIONS Alcohol consumption is prevalent among Chinese adolescents, with some even classified as hazardous drinkers. These findings may offer valuable insights for policymakers and caregivers, guiding them in formulating appropriate interventions and support strategies.
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Affiliation(s)
- Ling Li
- Department of Psychiatry, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yi Liu
- Department of Psychiatry, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Zhangming Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Silan Ren
- Department of Nursing, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China
| | - Ruini He
- Department of Psychiatry, Zigong Mental Health Center, Zigong, Sichuan, China
| | - Yudiao Liang
- Department of Psychiatry, Zigong Mental Health Center, Zigong, Sichuan, China
| | - Youguo Tan
- Department of Psychiatry, Zigong Mental Health Center, Zigong, Sichuan, China
| | - Xu Shao
- Department of Psychiatry, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Shanshan Chen
- Department of Psychiatry, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Xiangjuan Kong
- Department of Psychiatry, Daizhuang Hospital, Jining, Shandong, China
| | - Jinsong Tang
- Department of Psychiatry, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Xiaogang Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanhui Liao
- Department of Psychiatry, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
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3
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Vranken S, Matthes J, Fitzgerald K, Beullens K. I spy with my little eye: An eye-tracking study examining adolescents' attention to alcoholic and non-alcoholic beverages in Instagram stories. Appetite 2023; 189:107000. [PMID: 37573972 DOI: 10.1016/j.appet.2023.107000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
Social media users are frequently exposed to alcohol images on Instagram, which in turn influences their own alcohol behaviors. Yet, it is unclear what factors drive attention to alcohol cues. In an eye-tracking study (N = 108; Mage = 16.54), we examined adolescents' attention to Instagram Stories depending on: (a) the type of beverage depicted (beer vs water), (b) the character-product interaction portrayed (CPI: peers in images shown consuming [high CPI] vs holding beverages [low CPI]) and, (c) participant's own susceptibility (high vs low-risk alcohol drinker). Our results illustrated that adolescents allocated an equal amount of attention to beer and water depicted in Instagram images. Furthermore, they devoted more attention to Instagram images wherein peers were shown consuming water and beer (high CPI) compared to those wherein peers were holding these beverages (low CPI). Surprisingly, high-risk alcohol drinkers were more responsive to both beer and water cues than low-risk drinkers. This was particularly the case for Instagram images with high CPI. These findings have implications for how health cues on Instagram are attended to and processed.
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Affiliation(s)
- Sofie Vranken
- School for Mass Communication Research - University of Leuven, Parkstraat 45 (Box 3603), B-3000, Leuven, Belgium; Research Foundations Flanders (FWO), Egmontstraat 5, 1000, Brussels, Belgium.
| | - Jörg Matthes
- Advertising and Media Effects Research Group - University of Vienna, Währinger Straße 29, 1090, Vienna, Austria
| | - Kaitlin Fitzgerald
- College of Human Ecology, Cornell University, Martha Van Rensselaer HallIthaca, NY, 14853, USA
| | - Kathleen Beullens
- School for Mass Communication Research - University of Leuven, Parkstraat 45 (Box 3603), B-3000, Leuven, Belgium
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4
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Sarkar PR, Friedmann PD. Screening Adolescents for Substance Use: a Four-Step Approach for Trainees. Acad Psychiatry 2023; 47:550-555. [PMID: 37658957 DOI: 10.1007/s40596-023-01848-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Pooja R Sarkar
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School - Baystate Medical Center and Baystate Health, Springfield, MA, USA
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5
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Fantini L, Gostoli S, Artin MG, Rafanelli C. An intervention based on Well-Being Therapy to prevent alcohol use and other unhealthy lifestyle behaviors among students: a three-arm cluster randomized controlled trial. PSYCHOL HEALTH MED 2023:1-21. [PMID: 37467370 DOI: 10.1080/13548506.2023.2235740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
Unhealthy lifestyle, such as alcohol use, and negative health outcomes have been associated with impairments in psychological well-being. The primary objective of the study was to test the efficacy of an intervention based on Well-Being Therapy to prevent or stem alcohol use, binge drinking and other unhealthy lifestyle among Italian adolescents in school settings. A three-arm cluster randomized controlled trial including three test periods (baseline, post-test, six-month follow-up) was implemented. Seven classes (144 students) were randomly assigned to receive well-being intervention (WBI), lifestyle intervention (LI), or no intervention (NI). Primary outcomes were alcohol use (AUDIT-C), binge drinking and other unhealthy lifestyle behaviors (i.e. unhealthy diet, physical inactivity, tobacco and cannabis smoking, poor sleep and Internet addiction). Linear mixed models and mixed-effects logistic regression were used to test the efficacy of WBI in comparison with LI and NI. At six-month follow-up, AUDIT-C total score increased more in NI in comparison with WBI (p = 0.044) and LI (p = 0.016), whereas the odds of being classified as at-risk drinker were lower in WBI (p = 0.038) and LI (p = 0.002), than NI. Only WBI showed a protective effect for cannabis use at post-test in comparison with NI (p = 0.003) and LI (p = 0.014). Sleep hours at night decreased more in NI than in LI (p = 0.027) at six months. Internet addiction decreased more in WBI (p = 0.002) and LI (p = 0.005) at post-test in comparison with NI. Although both interventions showed a positive impact on adolescent lifestyle, the positive effect of WBI on cannabis use underlines how this approach might be promising to stem adolescents' substance use.
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Affiliation(s)
- Luana Fantini
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Sara Gostoli
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Michael G Artin
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Chiara Rafanelli
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
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Juntunen A, Määttä S, Könönen M, Kallioniemi E, Niskanen E, Kaarre O, Kivimäki P, Vanninen R, Tolmunen T, Ferreri F, Kekkonen V. Cortical thickness is inversely associated with transcranial magnetic stimulation-evoked N45 potential among young adults whose heavy drinking began in adolescence. Alcohol Clin Exp Res 2023; 47:1341-1351. [PMID: 37526579 DOI: 10.1111/acer.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Adolescence is a particularly vulnerable stage of development in terms of the deleterious effects of alcohol. Both lower gray matter (GM) volume and greater GABAergic activity have been associated with chronic alcohol consumption during adolescence. However, the association between these measures has not been investigated. METHODS In this exploratory study, we compared 26 young adults with a 10year history of heavy alcohol consumption with 21 controls who used little or no alcohol. Simultaneous transcranial magnetic stimulation and electroencephalography were used to assess transcranial magnetic stimulation-evoked N45 potentials, reflecting a balance between GABAergic inhibition and N-methyl-D-aspartate (NMDA) receptor-mediated glutaminergic excitation in the brain. GM thickness was measured from magnetic resonance images and GM and N45 potentials were then correlated. RESULTS Cortical thickness was significantly lower in several brain regions in the heavy-drinking group than the light-drinking group. The N45 amplitude was significantly larger frontally in the heavy-drinking group. Among heavy drinkers, there were several statistically significant correlations between thinner GM and larger frontal N45 amplitudes that were not detectable in the light-drinking group. The strongest correlations were detected in the frontal and parietal lobes, especially in the left superior frontal gyrus and the left supramarginal gyrus, and in both hemispheres in the superior parietal lobes. CONCLUSIONS These findings show that a thinner cortex and greater inhibitory neurotransmission are correlated in certain brain regions among young, long-term heavy alcohol users. Studies are needed to explore the possible causal mechanisms underlying these effects.
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Affiliation(s)
- Anna Juntunen
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
| | - Sara Määttä
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Elisa Kallioniemi
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Eini Niskanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Outi Kaarre
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
- Forensic Psychiatry Clinic of the University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Petri Kivimäki
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
- Vuosaari Psychiatric Outpatient Clinic, Vuosaari Health and Well-being Centre, City of Helsinki, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Tommi Tolmunen
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Florinda Ferreri
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Unit of Clinical Neurophysiology and Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Virve Kekkonen
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland
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7
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O'Reilly L, Elam KK, Quinn PD, Adams S, Chirica MG, Klonsky ED, Pettersson E, Lundström S, Larsson H, Lichtenstein P, D'Onofrio B. Examining protective factors for substance use problems and self-harm behavior during adolescence: A longitudinal co-twin control study. Dev Psychopathol 2022; 34:1-22. [PMID: 35968852 PMCID: PMC9929025 DOI: 10.1017/s0954579422000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sports participation, physical activity, and friendship quality are theorized to have protective effects on the developmental emergence of substance use and self-harm behavior in adolescence, but existing research has been mixed. This ambiguity could reflect, in part, the potential for confounding of observed associations by genetic and environmental factors, which previous research has been unable to rigorously rule out. We used data from the prospective, population-based Child and Adolescent Twin Study in Sweden (n = 18,234 born 1994-2001) and applied a co-twin control design to account for potential genetic and environmental confounding of sports participation, physical activity, and friendship quality (assessed at age 15) as presumed protective factors for adolescent substance use and self-harm behavior (assessed at age 18). While confidence intervals widened to include the null in numerous co-twin control analyses adjusting for childhood psychopathology, parent-reported sports participation and twin-reported positive friendship quality were associated with increased odds of alcohol problems and nicotine use. However, parent-reported sports participation, twin-reported physical activity, and twin-reported friendship quality were associated with decreased odds of self-harm behavior. The findings provide a more nuanced understanding of the risks and benefits of putative protective factors for risky behaviors that emerge during adolescence.
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Affiliation(s)
- Lauren O'Reilly
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Kit K Elam
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Patrick D Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Sydney Adams
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Marianne G Chirica
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - E David Klonsky
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian D'Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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8
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Deluca P, Coulton S, Alam MF, Boniface S, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury‐Birch D, Patton R, Pellat‐Higgins T, Phillips C, Phillips T, Pockett RD, Russell IT, Strang J, Drummond C. Effectiveness and cost-effectiveness of face-to-face and electronic brief interventions versus screening alone to reduce alcohol consumption among high-risk adolescents presenting to emergency departments: three-arm pragmatic randomized trial (SIPS Junior high risk trial). Addiction 2022; 117:2200-2214. [PMID: 35315170 PMCID: PMC9540754 DOI: 10.1111/add.15884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Alcohol use increases throughout adolescence. Emergency department (ED) attendance is an opportunity for alcohol screening and brief intervention (ASBI), which is effective for adults. This trial evaluated the effectiveness and cost-effectiveness of ASBI compared with screening alone (SA) in high-risk adolescents. DESIGN, SETTING AND PARTICIPANTS Multi-centre, three-group, single-blind, individually randomized trial with follow-ups after 6 and 12 months in 10 ED settings in England. From October 2014 to May 2015 we screened 3327 adolescents aged 14 to 18 years, of whom 756 (22.7%) scored at least 3 on the Alcohol Use Disorders Identification Test: consumption (AUDIT-C) and consented to participate in this trial. Mean age was 16.1 years; 50.2% were female and 84.9% were white. INTERVENTIONS Interventions were personalized feedback and brief advice (PFBA), personalized feedback plus electronic brief intervention (eBI) and SA. MEASURES The primary outcome was the weekly alcohol consumed in standard UK units (8 g ethanol) at 12 months post-randomization, derived from extended AUDIT-C. Economic outcomes included quality of life and service use, from perspectives of both the National Health Service and personal social services (NHS&PSS) and society. FINDINGS At 12 months, mean weekly consumption was 2.99 [95% confidence interval (CI) = 2.38-3.70] standard units for the SA group, 3.56 (95% CI = 2.90, 4.32) for PFBA and 3.18 (95% CI = 2.50, 3.97) for eBI, showing no significant differences. The PFBA group consumed mean 0.57 (-0.36, 1.70) units more than SA; and eBIs consumed 0.19 (-0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non-significance. From the NHS&PSS perspective, economic analysis showed that PFBA and eBI were not cost-effective compared with SA: PFBA yielded incremental cost-effectiveness ratio of £6213 (-£736 843, £812 884), with the intervention having 54% probability of being cost-effective compared with SA at the £20 000 WTP threshold. CONCLUSIONS In emergency departments in England, neither personalized feedback and brief advice nor personalized feedback plus electronic brief intervention showed evidence of being effective or cost-effective when compared with screening alone in reducing alcohol consumption among adolescents.
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Affiliation(s)
- Paolo Deluca
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Simon Coulton
- Centre for Health Services StudiesUniversity of KentCanterburyUK
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU HealthQatar UniversityQatar
| | - Sadie Boniface
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Institute of Alcohol StudiesAlliance HouseLondonUK
| | - Kim Donoghue
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas HospitalNewcastle upon TyneUK,Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Eileen Kaner
- Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Ellen Lynch
- Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Ian Maconochie
- Paediatric Emergency MedicineImperial College London, Queen Elizabeth the Queen Mother Wing, St Mary's HospitalLondonUK
| | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas HospitalNewcastle upon TyneUK
| | - Ruth McGovern
- Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | | | - Robert Patton
- School of Psychology, Elizabeth Fry Building (AD)University of SurreyGuildfordUK
| | | | | | - Thomas Phillips
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Institute for Clinical and Applied Health ResearchUniversity of HullHullUK
| | | | - Ian T. Russell
- Swansea Centre for Health Economics, College of Human and Health SciencesSwansea UniversitySwanseaUK
| | - John Strang
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Colin Drummond
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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9
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Cannizzaro E, Lavanco G, Castelli V, Cirrincione L, Di Majo D, Martines F, Argo A, Plescia F. Alcohol and Nicotine Use among Adolescents: An Observational Study in a Sicilian Cohort of High School Students. Int J Environ Res Public Health 2022; 19:6152. [PMID: 35627691 PMCID: PMC9140855 DOI: 10.3390/ijerph19106152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 12/24/2022]
Abstract
In recent years, the mode of alcoholic intake known as binge drinking (BD) has become a common practice, especially among adolescents who, due to socio-environmental motives, tend to reach a rapid state of drunkenness. This drunkeness leads to alterations in brain areas responsible for executive functions and cognitive processes, as well as to the genesis of factors that predispose to lasting addiction. Likewise, nicotine leads to a comparable degree of addiction. On this basis, the aim of this research was to evaluate, on a cohort of 349 high school students (15−17 years old) in the province of Palermo, the following: (I) the drinking model of alcoholic beverages; (II) the use of nicotine and the degree of dependence; (III) the correlation between the consumption of alcoholic beverages and the use of nicotine. We employed the AUDIT-C test and the Fagerström test, two valid and standard instruments, in order to assess alcohol and nicotine use, respectively. Statistical analysis of the data showed that male and female students consumed alcohol prominently in a BD mode (77.2%, audit score (AS) 3.497, confidence interval (CI) 3.206−3.788; 69.6%, AS 2.793, CI 2.412−3.274) and nicotine (41.5%, Fagerström score (FS) 3.882, CI 3.519−4.245; 28%, FS 3.286, CI 2.547−4.024). Furthermore, a positive correlation between alcohol consumption and nicotine use was found for male (r = 0.6798, p < 0.0001) and female (r = 0.6572, p < 0.0001) students. This study provided further insights into the use of legal substances of abuse in adolescents, evidencing the obvious need for the promotion of specific school educational programs aimed at the wellbeing of youth populations.
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Affiliation(s)
- Emanuele Cannizzaro
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (E.C.); or (G.L.); (L.C.); (A.A.)
| | - Gianluca Lavanco
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (E.C.); or (G.L.); (L.C.); (A.A.)
| | - Valentina Castelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (V.C.); (D.D.M.); (F.M.)
| | - Luigi Cirrincione
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (E.C.); or (G.L.); (L.C.); (A.A.)
| | - Danila Di Majo
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (V.C.); (D.D.M.); (F.M.)
| | - Francesco Martines
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (V.C.); (D.D.M.); (F.M.)
| | - Antonina Argo
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (E.C.); or (G.L.); (L.C.); (A.A.)
| | - Fulvio Plescia
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (E.C.); or (G.L.); (L.C.); (A.A.)
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McArdle P, Coulton S, Kaner E, Gilvarry E, Drummond C. Alcohol Misuse among English Youth, Are Harms Attributable to Alcohol or to Underlying Disinhibitory Characteristics? Alcohol Alcohol 2022; 57:372-377. [PMID: 34875694 DOI: 10.1093/alcalc/agab077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Alcohol use by young people is associated with a range of psychological and physical harms. However, similar harms are also reported with disinhibitory conditions such as conduct problems that are said to precede and predispose to alcohol misuse. We explored whether alcohol use or indicators of underlying disinhibition predict psychological and physical harms in a cohort of young people. METHODS We used data from a randomised controlled intervention trial that identified young people who consumed alcohol (n = 756), mean age = 15.6 years, attending emergency departments (EDs) in England. Disinhibition was measured by the self-report Strengths and Difficulties Questionnaire hyperactivity and conduct problem items, and alcohol-related harms by questions from the ESPAD, a major European school survey. We conducted a mediation analysis with a primary outcome of frequency of engaging in alcohol-related harms 12 months after screening in ED, exploring for the mediating influence of alcohol consumed at six months. We included age, gender, allocated group and baseline consumption as covariates and adjusted for the multi-level nature of the study, where young people were nested within EDs. RESULTS Conduct problems and to a lesser extent hyperactivity predicted harms at twelve months. This effect was not mediated by alcohol consumed at 6 months. CONCLUSIONS Among young drinkers underlying behavioural attributes predict harm independently of alcohol use. This suggests that the harms associated with alcohol use are attributable more to underlying disinhibitory characteristics than the quantity of alcohol consumed.
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Affiliation(s)
- Paul McArdle
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, NE3 3XT, Newcastle upon Tyne, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, Kent CT2 7NF, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, NE2 4AX, Newcastle-upon-Tyne, UK
| | - Eilish Gilvarry
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, NE3 3XT, Newcastle upon Tyne, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 de Crespigny Park, London SE5 8AF, UK
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11
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Coulton S, Giles EL, McGeechan GJ, Deluca P, Drummond C, Howel D, Kaner E, McColl E, McGovern R, Scott S, Sumnall H, Vale L, Albani V, Boniface S, Ferguson J, Gilvarry E, Hendrie N, Howe N, Ramsay A, Newbury-Birch D. The Effectiveness and Cost-Effectiveness of Screening and Brief Alcohol Intervention to Reduce Alcohol Consumption in Young People in the High School Setting: A Pragmatic Randomized Controlled Trial (SIPS JR-HIGH). Alcohol Alcohol 2022; 57:261-269. [PMID: 35134128 PMCID: PMC8919403 DOI: 10.1093/alcalc/agab087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Emma L Giles
- School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Grant J McGeechan
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Paolo Deluca
- Institute of Psychiatry, Psychology & Neuroscience, King’s College, London, UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King’s College, London, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Stephanie Scott
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Harry Sumnall
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Viviana Albani
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Jennifer Ferguson
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - Eilish Gilvarry
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | - Nadine Hendrie
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle-upon-Tyne, UK
| | - Amy Ramsay
- Institute of Psychiatry, Psychology & Neuroscience, King’s College, London, UK
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12
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Deluca P, Coulton S, Alam MF, Boniface S, Cohen D, Donoghue K, Gilvarry E, Kaner E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Pellatt-Higgins T, Phillips C, Phillips T, Pockett RD, Russell I, Strang J, Drummond C. Brief interventions to prevent excessive alcohol use in adolescents at low-risk presenting to Emergency Departments: Three-arm, randomised trial of effectiveness and cost-effectiveness. Int J Drug Policy 2021; 93:103113. [PMID: 33487528 PMCID: PMC8261826 DOI: 10.1016/j.drugpo.2021.103113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND Alcohol consumption and related harm increase rapidly from the age of 12 years. We evaluated whether alcohol screening and brief intervention is effective and cost-effective in delaying hazardous or harmful drinking amongst low-risk or abstaining adolescents attending Emergency Departments (EDs). METHODS This ten-centre, three-arm, parallel-group, single-blind, pragmatic, individually randomised trial screened ED attenders aged between 14 and 17 years for alcohol consumption. We sampled at random one third of those scoring at most 2 on AUDIT-C who had access to the internet and, if aged under 16, were Gillick competent or had informed consent from parent or guardian. We randomised them between: screening only (control intervention); one session of face-to-face Personalised Feedback and Brief Advice (PFBA); and PFBA plus an electronic brief intervention (eBI) on smartphone or web. We conducted follow-up after six and 12 months. The principal outcomes were alcohol consumed over the 3 months before 12-month follow up, measured by AUDIT-C; and quality-adjusted life-years. FINDINGS Between October 2014 and May 2015, we approached 5,016 eligible patients of whom 3,326 consented to be screened and participate in the trial; 2,571 of these were low-risk drinkers or abstainers, consuming an average 0.14 units per week. We randomised: 304 to screening only; 285 to PFBA; and 294 to PFBA and eBI. We found no significant difference between groups, notably in weekly alcohol consumption: those receiving screening only drank 0.10 units (95% confidence interval 0.05 to 0.18); PFBA 0.12 (0.06 to 0.21); PFBA and eBI 0.10 (0.05 to 0.19). INTERPRETATION While drinking levels remained low in this population, this trial found no evidence that PFBA with or without eBI was more effective than screening alone in reducing or delaying alcohol consumption.
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Affiliation(s)
- Paolo Deluca
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK.
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Sadie Boniface
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK
| | - David Cohen
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK
| | - Kim Donoghue
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK
| | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College, London, UK
| | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Robert Patton
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Ceri Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, Wales, UK
| | - Thomas Phillips
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK,Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Rhys D. Pockett
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, Wales, UK
| | - Ian Russell
- Medical School, Swansea University, Swansea, Wales, UK
| | - John Strang
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK
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13
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Gamblin D, Tobutt C, Patton R. Alcohol identification and brief advice in England’s criminal justice system: a review of the evidence. Journal of Substance Use 2020. [DOI: 10.1080/14659891.2020.1745311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- David Gamblin
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom of Great Britain and Northern Ireland
| | - Clive Tobutt
- Department of Interprofessional Studies, University of Winchester, Winchester, United Kingdom of Great Britain and Northern Ireland
| | - Robert Patton
- School of Psychology, University of Surrey, Guildford, United Kingdom of Great Britain and Northern Ireland
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14
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Deluca P, Coulton S, Alam MF, Boniface S, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Pellatt-Higgins T, Phillips C, Phillips T, Pockett R, Russell IT, Strang J, Drummond C. Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs. Programme Grants Appl Res 2020. [DOI: 10.3310/pgfar08020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs).
Objectives
To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions.
Design
The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs).
Setting
Twelve EDs in England (London, North East, and Yorkshire and The Humber).
Participants
A total of 5376 participants in the prevalence study [mean age 13.0 years, standard deviation (SD) 2.0 years; 46.2% female] and 1640 participants in the two linked RCTs (mean age 15.6 years, SD 1.0 years; 50.7% female).
Interventions
Personalised feedback and brief advice (PFBA) and personalised feedback plus electronic brief intervention (eBI), compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews.
Main outcome measures
Total alcohol consumed in standard UK units (1 unit = 8 g of ethanol) over the previous 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test, Consumption (3 items) (AUDIT-C).
Results
In the prevalence study, 2112 participants (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at the age of 17 years. The prevalence of at-risk alcohol consumption was 15% [95% confidence interval (CI) 14% to 16%] and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was ≥ 3. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found. In the RCT, the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial, the mean difference compared with control was 0.57 (95% CI –0.36 to 1.70) for PFBA and 0.19 (95% CI –0.71 to 1.30) for eBI. In the low-risk drinking trial, the mean difference compared with control was 0.03 (95% CI –0.07 to 0.13) for PFBA and 0.01 (95% CI –0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost-effective than screening alone.
Conclusions
The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol-related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study. The trials were feasible to implement and exceeded the recruitment target and minimum follow-up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14- to 17-year-olds attending EDs.
Limitations and future work
Only one-third of participants engaged with the application program; this is likely to have limited the effect of the intervention. We recommend that future research should focus on methods to maximise engagement with digital interventions and evaluate the effect of such engagement on clinical outcomes.
Trial registration
Current Controlled Trials ISRCTN45300218.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paolo Deluca
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Sadie Boniface
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kim Donoghue
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ellen Lynch
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College London, London, UK
| | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Robert Patton
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Ceri Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Thomas Phillips
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Rhys Pockett
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - John Strang
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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15
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Giles EL, McGeechan GJ, Coulton S, Deluca P, Drummond C, Howel D, Kaner E, McColl E, McGovern R, Scott S, Stamp E, Sumnall H, Todd L, Vale L, Albani V, Boniface S, Ferguson J, Gilvarry E, Hendrie N, Howe N, Mossop H, Ramsay A, Stanley G, Newbury-Birch D. Brief alcohol intervention for risky drinking in young people aged 14–15 years in secondary schools: the SIPS JR-HIGH RCT. Public Health Res 2019. [DOI: 10.3310/phr07090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Adverse effects from young people’s alcohol consumption manifest in a range of physical and psychosocial factors, including neurological issues, cognitive impairment and risk-taking behaviours. The SIPS JR-HIGH pilot trial showed alcohol screening and brief intervention (ASBI) to be acceptable to young people and schools in the north-east of England.
Objectives
To conduct a two-arm, individually randomised controlled trial to evaluate the effectiveness and cost-effectiveness of ASBI for risky drinking in young people aged 14–15 years in the school setting, to monitor the fidelity of ASBI and to explore the barriers to, and facilitators of, implementation with staff, young people and parents.
Design
A baseline survey with a 12-month follow-up. Interviews with 30 school staff, 21 learning mentors and nine teachers, and 33 young people and two parents.
Setting
Thirty state schools in four areas of England: north-east, north-west, Kent and London.
Participants
Year 10 school pupils who consented to the study (aged 14–15 years, recruited between November 2015 and June 2016), school-based staff and parents of the young people who took part in the study.
Interventions
Young people who screened positively on a single alcohol screening question and consented were randomised to the intervention or control arm (blinded). The intervention was a 30-minute one-to-one structured brief intervention with a trained learning mentor and an alcohol leaflet. The control group received a healthy lifestyle leaflet (no alcohol information).
Main outcome measures
The primary outcome measure was total alcohol consumed in the last 28 days. Secondary outcomes related to risky drinking, general psychological health, sexual risk-taking, energy drink consumption, age of first smoking, quality of life, quality-adjusted life-years, service utilisation and demographic information.
Results
A total of 4523 young people completed the baseline survey, with 1064 screening positively (24%) and 443 being eligible to take part in the trial. Of those 443, 233 (53%) were randomised to the control arm and 210 were randomised to the intervention arm. Of the 443, 374 (84%) were successfully followed up at 12 months (intervention, n = 178; control, n = 196). The results were that the intervention showed no evidence of benefit for any alcohol-related measure when compared with the control arm. At 12 months we found a reduction from 61.9% to 43.3% using the Alcohol Use Disorders Identification Test cut-off point of 8 and cut-off point of 4 (69.0% to 60.7%). These results were not significant. A cost-effectiveness analysis showed that the average net cost saving of the brief intervention was £2865 (95% confidence interval –£11,272 to £2707) per year compared with usual practice, with the intervention showing a 76% probability of being cost saving compared with usual practice. The interview findings showed that school was an acceptable setting to carry out ASBI among staff and young people.
Limitations
Recruitment of parents to take part in interviews was poor. Only 18 ASBI sessions were recorded, making it difficult to assess internal validity.
Conclusions
Although the intervention was ineffective in reducing risky drinking in young people aged 14–15 years, it was well received by the young people and school staff who participated.
Future work
Uniform reporting of the outcomes used for ASBI would generate more robust conclusions on the effectiveness of ASBI in the future. Pilot feasibility studies should include more than one geographical area. Future work on involving parents is needed.
Trial registration
Current Controlled Trials ISRCTN45691494.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emma L Giles
- School of Health & Social Care, Teesside University, Middlesbrough, UK
| | - Grant J McGeechan
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Paolo Deluca
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie Scott
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - Elaine Stamp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Harry Sumnall
- Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
| | - Liz Todd
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Viviana Albani
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sadie Boniface
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Jennifer Ferguson
- School of Health & Social Care, Teesside University, Middlesbrough, UK
| | - Eilish Gilvarry
- Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Nadine Hendrie
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Mossop
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Amy Ramsay
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Grant Stanley
- Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
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16
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Devcic S, Sekulic D, Ban D, Kutlesa Z, Rodek J, Sajber D. Evidencing Protective and Risk Factors for Harmful Alcohol Drinking in Adolescence: A Prospective Analysis of Sport-Participation and Scholastic-Achievement in Older Adolescents from Croatia. Int J Environ Res Public Health 2018; 15:E986. [PMID: 29757974 DOI: 10.3390/ijerph15050986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 12/22/2022]
Abstract
Background: The prevalence of alcohol drinking (AD) in Croatian adolescents is alarming, but there is an evident lack of prospective analyses of the protective/risk factors of AD. This study aimed to prospectively investigate the relationships between scholastic and sport factors and harmful alcohol drinking (HD) in older adolescents. Methods: The participants (n = 644, 53.7% females) were 16 years of age at study baseline and were tested at baseline and again 20 months later (follow-up). The predictors included four variables of scholastic achievement and four factors evidencing involvement in sport. Criterion was AD observed on the Alcohol Use Disorders Identification Test (AUDIT), and results were later categorized into harmful drinking (HD) and non-harmful drinking (NHD). The HD at baseline, HD at follow-up and HD initiation during the study course were observed as criteria in logistic regression analyses, which were additionally controlled for confounders (age, gender, socioeconomic status, and conflict with parents). Results: With 22% and 29% adolescents who reported HD at baseline and follow-up, respectively, the prevalence of HD remains among the highest in Europe. Scholastic failure was systematically related to HD at baseline and follow-up, but scholastic variables did not predict HD initiation during the course of the study. The higher odds for HD at baseline were evidenced for current and former team sport athletes. Those who quit individual sport were more likely to engage in HD at follow-up. Longer involvement in sport (OR: 2.10, 95% CI: 1.18–3.72), higher sport result (OR: 3.15, 95% CI: 1.19–8.34), and quitting individual sport (OR: 13.13, 95% CI: 2.67–64.62) were predictive of HD initiation. Conclusions: The results indicated specific associations between sport factors with HD initiation, which is understandable knowing the high stress placed on young athletes in this period of life, mainly because of the forthcoming selection between junior (amateur) and senior (professional) level. The results did not allow interpretation of the cause-effect relationship between scholastic failure and HD in the studied period.
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