Engagement with mHealth Alcohol Interventions: User Perspectives on an App or Chatbot-Delivered Program to Reduce Drinking

Research suggests participant engagement is a key mediator of mHealth alcohol interventions' effectiveness in reducing alcohol consumption among users. Understanding the features that promote engagement is critical to maximizing the effectiveness of mHealth-delivered alcohol interventions. The purpose of this study was to identify facilitators and barriers to mHealth alcohol intervention utilization among hazardous-drinking participants who were randomized to use either an app (Step Away) or Artificial Intelligence (AI) chatbot-based intervention for reducing drinking (the Step Away chatbot). We conducted semi-structured interviews from December 2019 to January 2020 with 20 participants who used the app or chatbot for three months, identifying common facilitators and barriers to use. Participants of both interventions reported that tracking their drinking, receiving feedback about their drinking, feeling held accountable, notifications about high-risk drinking times, and reminders to track their drinking promoted continued engagement. Positivity, personalization, gaining insight into their drinking, and daily tips were stronger facilitator themes among bot users, indicating these may be strengths of the AI chatbot-based intervention when compared to a user-directed app. While tracking drinking was a theme among both groups, it was more salient among app users, potentially due to the option to quickly track drinks in the app that was not present with the conversational chatbot. Notification glitches, technology glitches, and difficulty with tracking drinking data were usage barriers for both groups. Lengthy setup processes were a stronger barrier for app users. Repetitiveness of the bot conversation, receipt of non-tailored daily tips, and inability to self-navigate to desired content were reported as barriers by bot users. To maximize engagement with AI interventions, future developers should include tracking to reinforce behavior change self-monitoring and be mindful of repetitive conversations, lengthy setup, and pathways that limit self-directed navigation.

Personalized normative feedback for hazardous drinking among college women: Differential outcomes by history of incapacitated rape

OBJECTIVE

Personalized normative feedback (PNF) interventions are effective at reducing hazardous drinking in college. However, little is known about who is most receptive to PNF. College women with a history of alcohol-related incapacitated rape (IR) are at elevated risk for hazardous drinking, but it is unclear what impact intervention messaging may have on this group and how their outcomes compare to those without past IR. To address this gap, this study involved secondary data analysis of a large web-based clinical trial.

METHOD

Heavy drinking college women (N = 1,188) were randomized into PNF (n = 895) or control conditions (n = 293). Postintervention, women reported their reactions to intervention messaging. Hazardous drinking outcomes (typical drinking, heavy episodic drinking [HED], peak estimated blood alcohol content [eBAC], blackout frequency) were assessed at baseline and 12 months.

RESULTS

Past IR was reported by 16.3% (n = 194) of women. Women with a history of IR reported more baseline hazardous drinking and greater readiness to change than women without IR. For those who received PNF, history of IR related to greater perceived impact of the intervention, but no difference in satisfaction with the message. After controlling for baseline drinking, regressions revealed the effect of PNF was moderated by IR for frequency of HED at 12 months. Simple main effects revealed PNF was associated with lower levels of hazardous drinking at follow-up among women with past IR.

CONCLUSIONS

This initial investigation suggests PNF is a low resource and easily disseminated intervention that can have a positive impact on college women with past IR. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial

BACKGROUND

Substance use, particularly binge drinking of alcohol and noninjection substance use, is associated with increased risk for HIV infection among youth, but structured substance use screening and brief intervention are not often provided as part of HIV risk reduction.

OBJECTIVE

The purpose of the study was to test the efficacy of a fully automated electronic screening and brief intervention, called Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults presenting for HIV testing. Secondary objectives were reduction in sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention.

METHODS

Youth aged 16 years to 25 years who presented for HIV testing at community-based locations were recruited for study participation. Those who screened at moderate to high risk on the Alcohol Use Disorders Identification Test were randomized (1:1) to either an electronic brief intervention or a time-attention control. The primary outcome was change in alcohol use at 1, 3, 6, and 12-month follow-ups. Negative binomial and log binomial regression analyses with generalized estimating equations were conducted to evaluate the intervention efficacy.

RESULTS

Among a sample of 329 youth, there were no significant differences in alcohol use outcomes between conditions over time or at the 1, 3, 6, or 12-month time points. In terms of secondary outcomes, there was evidence of reduction in condomless insertive anal sex under the influence of alcohol and drugs at 12 months compared with 3 months in the intervention versus the attention control condition (incidence rate ratio=0.15, 95% CI 0.05-0.44); however, there were no other significant differences in sexual risk and no difference in PrEP engagement.

CONCLUSIONS

We found no effect of electronic brief intervention to reduce alcohol use and some effect on sexual risk among youth aged 16 years to 25 years who present for HIV testing.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT02703116; https://clinicaltrials.gov/ct2/show/NCT02703116.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-020-8154-6.

Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial

BACKGROUND

Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF.

OBJECTIVE

To address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties.

METHODS

We performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants' motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score.

RESULTS

Between October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by -10.5 (95% CI -19.5 to -1.5) units in the control arm and -28.2 (95% CI -36.9 to -19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of -3.9 (95% CI -6.2 to -1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial.

CONCLUSIONS

This study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04494594; https://tinyurl.com/34em6n9f.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/19720.

Finding the Right Balance: A Social Norms Intervention to Reduce Heavy Drinking in University Students

Introduction: Heavy alcohol consumption constitutes a major health risk among University students. Social relationships with peers strongly affect University students' perception of the drinking behavior of others, which in turn plays a crucial role in determining their own alcohol intake. University students tend to overestimate their peers' alcohol consumption – a belief that is associated with an increase in an individual's own consumption. Therefore, we implemented a social norms intervention with personalized normative feedback at a major University in Germany to reduce and prevent excessive drinking among University students.

Methods: Our intervention was part of a regular health monitoring survey. We invited all enrolled University students to take part in this survey on two occasions. A total of 862 University students completed the questionnaire, 563 (65.3%) of which received e-mail-based feedback upon request concerning their peers' and their own alcohol consumption. For the intervention group (n = 190) as well as the control group (no feedback requested; n = 101), we included only University students in the evaluation who overestimated their peers' alcohol use and indicated above average consumption of the peers. We applied analyses of variance to assess intervention effects with regard to the correction of overestimated group norms as well as University students' drinking behavior.

Results: Within the intervention group, we observed a significantly larger reduction of the previously overestimated behavioral norms compared to the control group (p < 0.001; ηp2 = 0.06). With regard to behavioral outcomes the intervention group showed a significantly larger reduction in the AUDIT-C score (p = 0.020; ηp2 = 0.03).

Discussion: Our study confirms previous research whereupon personalized, gender-specific and selective normative feedback is effective for alcohol prevention among University students. However, University students still overestimated their peers' alcohol intake after the intervention. Furthermore, we did not reach high-risk groups (University students with the highest alcohol intake) since no feedback was requested. Future studies should address factors influencing the impact of the intervention and reachability of selective groups.

Efficacy of a complex smartphone application for reducing hazardous alcohol consumption: Study protocol for a randomized controlled trial with analysis of in-app user behavior in relation to outcome

OBJECTIVE

The efficacy of alcohol reduction applications is variable, and the underlying factors are largely unknown. The aim of this study is threefold: evaluate the relationship between user engagement and intervention efficacy, investigate the efficacy of the different functions applied, and investigate the efficacy of the intervention application compared to control groups.

METHODS

A randomized controlled trial will be conducted to determine the efficacy of a newly developed smartphone application compared to the controls in reducing alcohol consumption at a 30, 60, 90, 120, 150, and 180 days follow-up. Hazardous drinkers, aged 18 years or older, will be recruited through web articles and will be randomized (blinded to their allocation), to receive one of the two versions of the application (educational or control application) for 30 days, or will be allocated to a wait-list control group. Function usage times will be recorded on a single-user level to determine the association between application usage and efficacy.

RESULTS

Data collection will be completed by July 2020, and follow-up will be completed by January 2021.

CONCLUSIONS

The evaluation of intervention efficacy as a function of user behavior will hopefully contribute to the science of developing more efficient alcohol intervention applications in the future.

Pilot Study of the Adaptation of an Alcohol, Tobacco, and Illicit Drug Use Intervention for Vulnerable Urban Young Adults

Objectives: There is limited information about the applicability and effectiveness of tobacco and illicit drug use interventions in urban and racial/ethnic minority youth, a population with great need for prevention of alcohol and drug use. We pilot-tested the feasibility of a behavioral intervention to reduce alcohol, tobacco, and illicit drug use among urban young adults in New Orleans, Louisiana. Study Design: The 12-week intervention pilot project was developed to be implemented at a community-based social service organization that provides educational, juvenile justice-related case management, and mentoring services to youth with substance use and incarceration histories. Methods: One-hour intervention sessions included interactive discussions and lesson reviews guided by a health educator and peer facilitators. Recruitment was done by case managers. Thirty African American young adults aged 16-21 years participated between January 2016 and July 2017. Results: We were able to adapt the 14-session intervention to a 12-session, weekly curriculum that was well-received by the target population. Average rating for each session was 9.5 ± 0.3 (scale 0-10). Youth were willing to engage in the program, but retention was low. Rates of alcohol and drug use were significantly higher within our pilot population than national estimates. We found no significant decreases in self-reported alcohol, tobacco, or illicit drug use after participation in the intervention. Conclusion: Results emphasize the need to devote additional educational resources to intervention and retention factors for vulnerable youth. Individuals often experiment with drugs during adolescence; thus, this period represents a prime opportunity for education and intervention.

Cultural Adaptation of 2 Evidence-Based Alcohol Interventions for Antiretroviral Treatment Clinic Patients in Vietnam

In Vietnam where alcohol use is culturally normative and little treatment is available, persons living with HIV (PLWH) who consume alcohol at unhealthy levels are at greatly increased risk for negative health outcomes. We describe the first systematic adaptation of 2 evidence-based alcohol interventions for use in Vietnam: a combined motivational enhancement therapy/cognitive behavioral therapy and a brief alcohol intervention. Using the situated information, motivation and behavioral skills model, and systematic procedures for tailoring evidence-based treatments, we identified core intervention content to be preserved and key characteristics to be tailored for relevance to the clinical setting. We describe the use of in-depth interviews with antiretroviral treatment clients and providers, expert input, and counselor training procedures to develop tailored manuals for counselors and clients. Adapting evidence-based alcohol treatments for global settings is facilitated by the use of a model of behavior change and systematic procedures to operationalize the approach.

Feasibility and Acceptability of a Text Message-Based Intervention to Reduce Overuse of Alcohol in Emergency Department Patients: Controlled Proof-of-Concept Trial

Background

Emergency department (ED) patients have high rates of risky alcohol use, and an ED visit offers an opportunity to intervene. ED-based screening, brief intervention, and referral to treatment (SBIRT) reduces alcohol use and health care costs. Mobile health (mHealth) interventions may expand the impact of SBIRTs but are understudied in low-resource ED populations.

Objective

The objective of this study was to assess the feasibility of and patient satisfaction with a text-based mHealth extension of an ED screening program to reduce risky alcohol use in low-income, urban patients.

Methods

Research assistants screened a convenience sample of ED patients in person for risky alcohol use via the Alcohol Use Disorders Identification Test (AUDIT). Patients who reported AUDIT scores ≥8 and <20 were informed of their AUDIT score and risk. RAs invited patients with SMS text message–capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), an SMS text message–based extension of the ED screening program. mROAD is a 7-day program of twice-daily SMS text messages based on the National Institutes of Health’s Rethinking Drinking campaign. Participants were allocated to a control group (daily sham text messages without specific guidance on behaviors, such as “Thanks for taking part!”) or to the mROAD intervention group. Patients were interviewed at 30 days to assess acceptability, satisfaction, and changes in drinking behavior. Satisfaction was examined descriptively. Pre and post measurements of drinking behaviors and motivation were compared, as were differences in change scores between the intervention arms.

Results

Of 1028 patients screened, 95 (9.2%) exhibited risky alcohol use based on AUDIT, and 23/95 (24%) of those patients did not own an SMS text messaging–capable phone; this left 72/95 (76%) eligible patients. Among eligible participants, 48/72 (67%) agreed to enroll; 31/48 (65%) achieved follow-up (18/24 (75%) in the intervention group and 13/24 (55%) in the control group). Participants who completed follow-up reported high satisfaction. Changes in behavior were similar between the arms. Overall, the number of drinking days reported in the prior 30 days decreased by 5.0 (95% CI 1.7-8.3; P=.004), and the number of heavy drinking days decreased by 4.1 (95% CI 1.0 to 7.15, P=.01). Patients reported an 11-point increase (95% CI 2.6-20, P=.01, 10% overall increase) in motivation to change alcohol use via the Change Questionnaire. The were no statistical differences in drinking days, heavy drinking days, or motivation to change between the arms.

Conclusions

The mROAD trial was feasible. Over three-quarters of ED patients with risky alcohol use owned a text message–capable phone, and two-thirds of these patients were willing to participate; only 1 patient opted out of the intervention. Although 35% of patients were lost to follow-up at 30 days, those patients who did follow up had favorable impressions of the program; more than 90% reported that SMS text messages were a “good way to teach,” and 89% of intervention arm participants enjoyed the program and found that the messages were motivating. Both the mROAD and sham message groups showed promising changes in alcohol use and motivation to change. mROAD is a feasible intervention that may reduce rates of risky alcohol use in ED patients.

Trial Registration

ClinicalTrials.gov NCT02158949; https://clinicaltrials.gov/ct2/show/NCT02158949

Screening, brief intervention, and referral to treatment for adolescent alcohol use in Canadian pediatric emergency departments: a national survey of pediatric emergency physicians

BACKGROUND

Problematic alcohol use is associated with detrimental cognitive, physiological and social consequences. In the emergency department (ED), Screening, Brief Intervention, and Referral to Treatment (SBIRT) is the recommended approach to identify and treat adolescent alcohol-related concerns, but is underused by physicians.

OBJECTIVE

This study examined pediatric emergency physicians’ perceptions of adolescent drinking and treatment, and their current self-reported SBIRT practices.

METHOD

Physicians in the Pediatric Emergency Research Canada database (n=245) received a 35-item questionnaire that was administered through a web-based platform and paper-based mail-outs. Recruitment followed a modified Dillman four-contact approach.

RESULTS

From October 2016 to January 2017, 166 pediatric emergency physicians (46.4% males; mean age=43.6 years) completed the questionnaire. The response rate was 67.8%. Physicians recognized the need (65%) and responsibility (86%) to address adolescent alcohol problems. However, confidence in knowledge and abilities for SBIRT execution was low. Twenty-five percent of physicians reported never having practiced all, or part of, SBIRT while 1.3% reported consistent SBIRT delivery for adolescents with alcohol-related visits. More alcohol education and counselling experience was associated with higher SBIRT use; however, physicians generally reported to have received minimal alcohol training. SBIRT practices were also associated with physician perceptions of problematic alcohol use and its treatability.

CONCLUSIONS

Pediatric emergency physicians acknowledge the need to address problematic adolescent alcohol use, but routine SBIRT use is lacking. Strategies to educate physicians about SBIRT and enhance perceived self-competency may improve SBIRT use. Effectiveness trials to establish SBIRT impact on patient outcomes are also needed.

Initial Progress Toward Development of a Voice-Based Computer-Delivered Motivational Intervention for Heavy Drinking College Students: An Experimental Study

BACKGROUND

Computer-delivered interventions have been shown to be effective in reducing alcohol consumption in heavy drinking college students. However, these computer-delivered interventions rely on mouse, keyboard, or touchscreen responses for interactions between the users and the computer-delivered intervention. The principles of motivational interviewing suggest that in-person interventions may be effective, in part, because they encourage individuals to think through and speak aloud their motivations for changing a health behavior, which current computer-delivered interventions do not allow.

OBJECTIVE

The objective of this study was to take the initial steps toward development of a voice-based computer-delivered intervention that can ask open-ended questions and respond appropriately to users' verbal responses, more closely mirroring a human-delivered motivational intervention.

METHODS

We developed (1) a voice-based computer-delivered intervention that was run by a human controller and that allowed participants to speak their responses to scripted prompts delivered by speech generation software and (2) a text-based computer-delivered intervention that relied on the mouse, keyboard, and computer screen for all interactions. We randomized 60 heavy drinking college students to interact with the voice-based computer-delivered intervention and 30 to interact with the text-based computer-delivered intervention and compared their ratings of the systems as well as their motivation to change drinking and their drinking behavior at 1-month follow-up.

RESULTS

Participants reported that the voice-based computer-delivered intervention engaged positively with them in the session and delivered content in a manner consistent with motivational interviewing principles. At 1-month follow-up, participants in the voice-based computer-delivered intervention condition reported significant decreases in quantity, frequency, and problems associated with drinking, and increased perceived importance of changing drinking behaviors. In comparison to the text-based computer-delivered intervention condition, those assigned to voice-based computer-delivered intervention reported significantly fewer alcohol-related problems at the 1-month follow-up (incident rate ratio 0.60, 95% CI 0.44-0.83, P=.002). The conditions did not differ significantly on perceived importance of changing drinking or on measures of drinking quantity and frequency of heavy drinking.

CONCLUSIONS

Results indicate that it is feasible to construct a series of open-ended questions and a bank of responses and follow-up prompts that can be used in a future fully automated voice-based computer-delivered intervention that may mirror more closely human-delivered motivational interventions to reduce drinking. Such efforts will require using advanced speech recognition capabilities and machine-learning approaches to train a program to mirror the decisions made by human controllers in the voice-based computer-delivered intervention used in this study. In addition, future studies should examine enhancements that can increase the perceived warmth and empathy of voice-based computer-delivered intervention, possibly through greater personalization, improvements in the speech generation software, and embodying the computer-delivered intervention in a physical form.

A text message intervention to reduce first year university students' alcohol use: A pilot experimental study

Objective

The aim of Orientation Week is to help new students acclimatize to university life. However, Orientation Week is characterized by heavy alcohol use and during this time students may develop drinking patterns that persist into the academic year. The aim of the current study was to refine a brief Ecological Momentary Intervention (EMI) and test its effectiveness in reducing students’ alcohol use during both Orientation Week and throughout the academic year.

Method

We conducted two focus groups with students who had received a pilot intervention. We then updated and trialled the intervention with students from two residential colleges (College 1 n = 117 and College 2 n = 269) who were assigned to either an Ecological Momentary Assessment (EMA) condition or an EMA-EMI condition. Students in both conditions reported their pre-university drinking and their drinking during Orientation Week and the academic year via text message. In addition to the EMA messages, during Orientation Week, participants in the EMA-EMI condition received messages highlighting the potential social consequences of heavy alcohol use.

Results

In College 1 those in the EMA-EMI condition consumed fewer drinks, relative to those in the EMA condition, across both Orientation Week (9.7 vs. 15.5; t(98) = 2.138, p = .018) and the academic year. (4.3 vs. 6.8; t(98) = 1.788, p = .039). There were, however, no significant differences between conditions in College 2.

Conclusion

The current findings suggest that EMIs may be successful under certain circumstances and may provide a simple, cost-effective means of intervening.

Feasibility and user perception of a fully automated push-based multiple-session alcohol intervention for university students: randomized controlled trial

Background

In recent years, many electronic health behavior interventions have been developed in order to reach individuals with unhealthy behaviors, such as risky drinking. This is especially relevant for university students, many of whom are risky drinkers.

Objective

This study explored the acceptability and feasibility in a nontreatment-seeking group of university students (including both risk and nonrisk drinkers), of a fully automated, push-based, multiple-session, alcohol intervention, comparing two modes of delivery by randomizing participants to receive the intervention either by SMS text messaging (short message service, SMS) or by email.

Methods

A total of 5499 students at Luleå University in northern Sweden were invited to participate in a single-session alcohol assessment and feedback intervention; 28.04% (1542/5499) students completed this part of the study. In total, 29.44% (454/1542) of those participating in the single-session intervention accepted to participate further in the extended multiple-session intervention lasting for 4 weeks. The students were randomized to receive the intervention messages via SMS or email. A follow-up questionnaire was sent immediately after the intervention and 52.9% (240/454) responded.

Results

No difference was seen regarding satisfaction with the length and frequency of the intervention, regardless of the mode of delivery. Approximately 15% in both the SMS (19/136) and email groups (15/104) would have preferred the other mode of delivery. On the other hand, more students in the SMS group (46/229, 20.1%) stopped participating in the intervention during the 4-week period compared with the email group (10/193, 5.2%). Most students in both groups expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. A striking difference was seen regarding when a message was read; 88.2% (120/136) of the SMS group read the messages within 1 hour in contrast to 45.2% (47/104) in the email group. In addition, 83.1% (113/136) in the SMS group stated that they read all or almost all the messages, compared with only 63.5% (66/104) in the email group.

Conclusions

Based on the feedback from the students, an extended, multiple-session, push-based intervention seems to be a feasible option for students interested in additional support after a single-session alcohol intervention. SMS as a mode of delivery seems to have some advantages over email regarding when a message is read and the proportion of messages read. However, more students in the SMS group stopped the intervention than in the email group. Based on these promising findings, further studies comparing the effectiveness of single-session interventions with extended multiple-session interventions delivered separately or in combination are warranted.

Efficiency of brief interventions on alcohol-related risks in occupational medicine

AIM

To evaluate the effectiveness of brief interventions (BIs) in reducing alcohol use among hazardous drinkers consulting their occupational doctors.

MATERIALS AND METHODS

DESIGN

Randomized controlled trial with 12-month follow-up, conducted between November 2004 and September 2006.

SETTING

Fifteen French regional occupational medicine centers with 147 doctors and 157 assistants who were trained in BI and screening with the AUDIT questionnaire.

PARTICIPANTS

We invited 33,488 individuals to fill out AUDIT. These patients were eligible if their scores were 6-12 for women and 7-12 for men, indicating hazardous drinking without dependence (found in 7.1% of respondents).

INTERVENTION

After randomization, BIs (informative advice using motivational approach, with 10-minute average duration) were performed by the occupational doctors. The control group received information booklets from the doctors' assistants.

MEASUREMENTS

Situations were evaluated 12 months after inclusion.

OUTCOME MEASURES

AUDIT scores, self-reported alcohol consumption (SRAC) and biological assays. The main criteria were the differences observed between groups for SRAC, the AUDIT score at follow-up, and any reduction in score between inclusion and final assessment. Success of intervention, which was defined as an AUDIT score below the hazardous drinking threshold at follow-up, was considered to analyze the variables associated with the efficiency of intervention.

RESULTS

The analyzed sample included 787 persons, among whom 435 were met again 12 months later. In the BI group, we found a lower AUDIT score (p = 0.01), a higher reduction in reported consumptions (-60 g/week versus -44 g/week, p = 0.04) and in AUDIT scores (p = 0.009). In the control group, 44.8% reduced their AUDIT scores below hazardous drinking thresholds, as compared to 51.6% in the BI group (p = 0.15). Success was associated with a significant reduction in biological and clinical indices.

CONCLUSIONS

Though the high attrition rate led to careful conclusions, BIs seem to be efficient in occupational medicine, in comparison with written information, which also seems to influence drinking behavior.

A systematic review of emergency department interventions for college drinkers

BACKGROUND

Alcohol use in college-age individuals is associated with increased injury risk. Many college drinkers end up in the emergency department (ED) as a result of their drinking, providing a unique opportunity to intervene.

OBJECTIVE

This systematic review evaluates the existing evidence for the use of brief ED interventions for alcohol use in the college-age population.

METHODS

A systematic search of on-line databases was conducted. Articles were limited to those in English published since 1990. Studies were included if they specifically studied 18- to 20-year-old alcohol users, if they were performed in an ED or acute care setting, and if an intervention regarding alcohol use was attempted.

RESULTS

There were 400 studies identified; 60 abstracts were reviewed, 18 full-text articles were evaluated, and 7 met the inclusion criteria for review. Eligible studies focused on alcohol use only, except for one study that addressed alcohol and other drug use. All examined changes in alcohol intake patterns as a primary outcome, and most also looked for reductions in alcohol-related harm. Each found reductions in alcohol intake patterns or reductions in alcohol-related harm in the intervention group, although some between-group differences were not statistically significant reductions.

CONCLUSION

Seven studies were identified that measured the outcomes of ED interventions for alcohol use in the college-age population. The studied interventions showed promise but had variable success. More research is needed to establish short- and long-term efficacy, specifically in high-risk underage college students.

A pre-post study on the appropriateness and effectiveness of a Web- and text messaging-based intervention to reduce problem drinking in emerging adults

BACKGROUND

Problem drinking, particularly risky single-occasion drinking (RSOD), also called "binge drinking", is widespread among adolescents and young adults in most Western countries. Few studies have tested the effectiveness of interventions to reduce RSOD in young people with heterogeneous and particularly lower educational background.

OBJECTIVE

To test the appropriateness and initial effectiveness of a combined, individually tailored Web- and text messaging (SMS)-based intervention program to reduce problem drinking in vocational school students.

METHODS

The fully automated program provided: (1) online feedback about an individual's drinking pattern compared to the drinking norms of an age- and gender-specific reference group, and (2) recurrent individualized SMS messages over a time period of 3 months. Generalized Estimating Equation (GEE) analyses were used to investigate the longitudinal courses of the following outcomes over the study period of 3 months: RSOD, alcohol-related problems, mean number of standard drinks per week, and maximum number of standard drinks on an occasion.

RESULTS

The program was tested in 36 school classes at 7 vocational schools in Switzerland. Regardless of their drinking behavior, 477 vocational school students who owned a mobile phone were invited to participate in the program. Of these, 364 (76.3%) participated in the program. During the intervention period, 23 out of 364 (6.3%) persons unsubscribed from participating in the program. The GEE analyses revealed decreases in the percentage of persons with RSOD from baseline (75.5%, 210/278) to follow-up assessment (67.6%, 188/278, P<.001), in the percentage of persons with alcohol-related problems (20.4%, 57/280 to 14.3%, 40/280, P=.009), and in the mean number of standard drinks per week: 13.4 (SD 15.3) to 11.3 (SD 14.0), P=.002. They also revealed a trend toward a decrease in the mean of the maximum number of drinks consumed on an occasion: 11.3 (SD 10.3) to 10.5 (SD 10.3), P=.08.

CONCLUSIONS

The results show high acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented within school classes.

Access to health care and heavy drinking in patients with diabetes or hypertension: implications for alcohol interventions

Supported by a National Institute of Alcoholism and Alcohol Abuse grant, this study examined associations between health care access and heavy drinking in patients with hypertension and diabetes. Using a sample of 7,428 US adults from the 2007 National Health Interview Survey data, multivariate logistic regressions were performed. Better access to health care, as indicated by regular source of care and frequent use of primary care, was associated with reduced odds of heavy drinking. Alcohol interventions may be more effective if targeted at patients with chronic conditions adversely affected by drinking. Future research needs to investigate factors facilitating such interventions.

Prevention of alcohol misuse among children, youths and young adults

BACKGROUND

Despite many activities to prevent risky alcohol consumption among adolescents and young adults there is an increase of alcohol intoxications in the group of ten to twenty year old juveniles.

OBJECTIVES

This report gives an overview about the recent literature as well as the German federal prevention system regarding activities concerning behavioral and policy prevention of risky alcohol consumption among children, adolescents and young adults. Furthermore, effective components of prevention activities are identified and the efficiency and efficacy of ongoing prevention programs is evaluated.

METHODS

A systematic literature review is done in 34 databases using Bool'sche combinations of the key words alcohol, prevention, treatment, children, adolescents and young adults.

RESULTS

401 studies were found and 59 studies were selected for the health technology assessment (HTA). Most of the studies are done in USA, nine in Germany. A family strengthening program, personalized computer based intervention at schools, colleges and universities, brief motivational interventions and policy elements like increase of prices and taxes proved effective.

DISCUSSION

Among the 59 studies there are three meta-analyses, 15 reviews, 17 randomized controlled trials (RCT) and 18 cohort studies. Despite the overall high quality of the study design, many of them have methodological weaknesses (missing randomization, missing or too short follow-ups, not clearly defined measurement parameters). The transferability of US-results to the German context is problematic. Only a few prevention activities reach a sustainable reduction of frequency and/or amount of alcohol consumption.

CONCLUSION

The HTA-report shows the need to develop specific and target group focused prevention activities for the German situation. Essential for that is the definition of target goals (reduction of consumption, change of behaviour) as well as the definition and empirical validation of risky alcohol consumption. The efficacy of prevention activities should be proven before they are launched. At present activities for the reduction or prevention of risky alcohol consumption are not sufficiently evaluated in Germany concerning their sustainable efficacy.

Fractures and alcohol abuse - patient opinion of alcohol intervention

PURPOSE

To clarify patient opinions about alcohol intervention in relation to surgery before investigating the effect in a Scandinavian multi-centre randomized trial.

MATERIAL AND METHODS

A qualitative study. Thirteen consecutive alcohol patients with fractures participated after informed consent. They were interviewed during their hospital stay. The number of participants was based on the criteria of data-saturation. The analysis followed the applied qualitative framework model aimed at evaluation of specific participant needs within a larger overall project.

RESULTS

All patients regarded alcohol intervention in relation to surgery as a good idea. They did not consider quit drinking as a major problem during their hospital stay and had all remained abstinent in this period. About half of the patients were ready or partly ready to participate in an alcohol intervention. Patient opinions and their readiness to participate were expressed in four groups, which also reflected their readiness to stop drinking in the perioperative period, their general acceptance of supportive disulfiram as part of an alcohol intervention as well as their awareness of postoperative complications.

CONCLUSION

This study clarified that the patients found alcohol intervention relevant in relation to surgery.

Help-seeking for alcohol-related problems in college students: correlates and preferred resources

Despite the development of a variety of efficacious alcohol intervention approaches for college students, few student drinkers seek help. The present study assessed students' history of help-seeking for alcohol problems, as well as their estimates of how likely they would be to use various help-seeking resources, should they wish to change their drinking. Participants were 197 college students who reported recent heavy drinking (46% male, 68.5% White, 27.4% African-American). Participants completed measures related to their drinking and their use (both past use and likelihood of future use) of 14 different alcohol help-seeking options. Repeated-measures analyses of variance revealed that students preferred informal help-seeking (e.g., talking to friends and family) over formal (e.g., talking with a counselor or medical provider) and anonymous resources (e.g., internet- or computer-based programs). Higher self-ideal discrepancy, greater depressive symptoms, and more alcohol-related consequences were positively associated with actual past help-seeking. Alcohol-related problems and normative discrepancy were negatively associated with hypothetical likelihood of utilizing all three help-seeking resources. These results suggest that heavy drinking college students prefer low-threshold intervention options including peer, family, computerized, and brief motivational interventions. Only 36 participants (18.3% of the sample) reported that they had utilized any of the help-seeking options queried, suggesting that campus prevention efforts should include both promoting low-threshold interventions and attempting to increase the salience of alcohol-related risk and the potential utility of changing drinking patterns.

Alcohol use in students seeking primary care treatment at university health services

OBJECTIVE

given the high rate of at-risk drinking in college students, the authors examined drinking behaviors and associated factors in students being seen in student health services for primary care visits from October 30, 2004, to February 15, 2007.

METHODS

analyses were based on a Health Screening Survey completed by 10,234 college students seeking general medical treatment.

RESULTS

alcohol use was similar to other studies with 57% (n = 5,840) meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking. Twenty-six percent of the students reported smoking at least once in the last 3 months. Risk factors for at-risk drinking included young age, white males, drinking at a fraternity/sorority house, and use of tobacco.

CONCLUSIONS

these findings support the widespread implementation of alcohol screening and intervention in university health services.