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Randomized Controlled Trial of Web-Based Alcohol Screening and Brief Intervention in Primary Care
Kypros Kypri, PhD;
John D. Langley, PhD;
John B. Saunders, MD;
Martine L. Cashell-Smith, BCom;
Peter Herbison, MSc
Arch Intern Med. 2008;168(5):530-536.
Background There is compelling evidence supporting screening and brief intervention (SBI) for hazardous drinking, yet it remains underused in primary health care. Electronic (computer or Web-based) SBI (e-SBI) offers the prospects of ease and economy of access. We sought to determine whether e-SBI reduces hazardous drinking.
Methods We conducted a randomized controlled trial in a university primary health care service. Participants were 975 students (age range, 17-29 years) screened using the Alcohol Use Disorders Identification Test (AUDIT). Of 599 students who scored in the hazardous or harmful range, 576 (300 of whom were women) consented to the trial and were randomized to receive an information pamphlet (control group), a Web-based motivational intervention (single-dose e-SBI group), or a Web-based motivational intervention with further interventions 1 and 6 months later (multidose e-SBI group).
Results Relative to the control group, the single-dose e-SBI group at 6 months reported a lower frequency of drinking (rate ratio [RR], 0.79; 95% confidence interval [CI], 0.68-0.94), less total consumption (RR, 0.77; 95% CI, 0.63-0.95), and fewer academic problems (RR, 0.76; 95% CI, 0.64-0.91). At 12 months, statistically significant differences in total consumption (RR, 0.77; 95% CI, 0.63-0.95 [equivalent to 3.5 standard drinks per week]) and in academic problems (RR, 0.80; 95% CI, 0.66-0.97) remained, and the AUDIT scores were 2.17 (95% CI, –1.10 to –3.24) points lower. Relative to the control group, the multidose e-SBI group at 6 months reported a lower frequency of drinking (RR, 0.85; 95% CI, 0.73-0.98), less total consumption (RR, 0.79; 95% CI, 0.64-0.97 [equivalent to 3.0 standard drinks per week]), reduced episodic heavy drinking (RR, 0.65; 95% CI, 0.45-0.93), and fewer academic problems (RR, 0.78; 95% CI, 0.65-0.93). At 12 months, statistically significant differences in academic problems remained (RR, 0.75; 95% CI, 0.62-0.90), while the AUDIT scores were 2.02 (95% CI, –0.97 to –3.10) points lower.
Conclusions Single-dose e-SBI reduces hazardous drinking, and the effect lasts 12 months. Additional sessions seem not to enhance the effect.
Trial Registration www.anzctr.org.au Identifier:ACTRN012607000103460
Author Affiliations: School of Medicine and Public Health, University of Newcastle, Newcastle (Dr Kypri), and Centre for Drug and Alcohol Studies, Department of Psychiatry, School of Medicine, University of Queensland, Brisbane, Australia (Dr Saunders); and Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand (Drs Kypri and Langley, Ms Cashell-Smith, and Mr Herbison). Dr Kypri is a fellow of the School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
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