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Reducing Alcohol Use Among 9th Grade Students: 6 Month Outcomes of a Brief, Web-Based Intervention

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Abstract

This study tested a brief, web-based personalized feedback program aimed at reducing alcohol use and alcohol-related consequences among 9th grade students (N = 513). Results indicated no differences between the control group and intervention group on either frequency of drinking or alcohol-related consequences at the 6-month follow-up. Reductions in alcohol use and the associated consequences found at the 3-month follow-up were not sustained across the academic year. Results indicate brief, web-based feedback programs may not be sufficient to provide a sustained impact on alcohol use and alcohol-related consequences over time, suggesting either booster sessions or adjunctive interventions, such as parent-based interventions, may be warranted for this age group.

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... Digital health interventions that combine motivation-enhancement and accurate peer norms may be especially well-suited to treat CINI youth in justice settings because they are accessible, customizable, portable, and show evidence of reducing cannabis use [34][35][36][37][38][39]. Among adolescents who receive brief computerized SU treatments [40], effects appear to fade over time [41], suggesting that adjunct treatments may be needed to help sustain gains. Smartphone apps are an especially appealing means of providing youth ongoing, on-demand care as an adjunct to concurrent or recently completed services (eg, continuing care and recovery support). ...
... Putative mediators include intrapersonal and interpersonal mechanisms of change; delinquent behavior is the sole secondary outcome. Brief motivation-enhancing treatments produce short-term decreases in cannabis and SU [40,41], but technological adjuncts can help maintain reductions in SU for up to 6 months [94]. Thus, we expect CINI youth to report the highest rates of cannabis and other SU at baseline, with small to moderate decreases at 1 month that maintain at 6 months. ...
... Brief, computerized interventions such as the ECTG program [56] can deliver evidence-based content with high fidelity, making them ideal for self-administration or delivery by a workforce without behavioral health training. However, similar to most brief approaches, gains achieved through brief computerized interventions can fade over time, including in samples of adolescents who use substances [40,41]. Digital adjuncts, like the TECH app, could provide a light touch of ongoing support to help bolster treatment gains. ...
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Background: Adolescents involved in the juvenile justice system who use cannabis are at an increased risk of future substance use disorders and rearrest. Many court-involved, nonincarcerated (CINI) youth are referred for services in the community and often encounter multiple barriers to care, highlighting the need for minimally burdensome services that can be delivered in justice settings. Digital health interventions are accessible, easy to implement, and can provide ongoing support but have not been developed to address the unique needs of CINI youth who use cannabis. Objective: This multiphase study will aim to develop, implement, and pilot test a novel smartphone app, Teen Empowerment through Computerized Health (TECH), to reduce cannabis and other substance use among CINI youth. TECH is conceptualized as a digital adjunct to a brief computerized intervention delivered by our family court partner. Methods: Following the principles of user-centered design, phase I interviews with CINI youth aged 14-18 years (n=14-18), their caregivers (n=6-8), and behavioral health app developers (n=6-8) will guide the TECH design decisions. Next, in phase II, CINI youth (n=10) will beta test the TECH app prototype for 1 month; their feedback regarding feasibility and acceptability will directly inform the app refinement process. Finally, in phase III, CINI youth (n=60) will participate in a pilot randomized controlled trial for 6 months, comparing the preliminary effectiveness of the adjunctive TECH app on cannabis use outcomes. Results: Phase I data collection began in September 2020 and was completed in December 2021; 14 CINI youth, 8 caregivers, and 11 behavioral health app developers participated in the study. Phases II and III will occur in 2022 and 2023 and 2023 and 2025, respectively. Conclusions: This body of work will provide insight into the feasibility and acceptability of a smartphone-based adjunctive intervention designed for CINI youth. Phase III results will offer a preliminary indication of the effectiveness of the TECH app in reducing cannabis use among CINI youth. International registered report identifier (irrid): DERR1-10.2196/35402.
... Of the nine identified interventions, six demonstrated significant, but modest, effects for alcohol and/or other drug use outcomes. Three papers reported results from trials evaluating web-based personalized feedback interventions to prevent alcohol or tobacco use [20][21][22]. One study was a trial of a web-based tailored smoking prevention program for 10-20 year olds, known as Smoke Alert [20]. ...
... Among students aged 14-16 years (n ¼ 385), smoking initiation was significantly lower in the intervention group than the control group at the 6-month follow-up. Two papers reported the 3-month and 6-month outcomes from another trial of a web-based personalized feedback intervention to prevent alcohol use [21,22]. A cluster RCT was conducted among Year 9 students (n ¼ 513, M age ¼ 14.2 years) from two schools in the United States to determine the effectiveness of the eCHECKUP TO GO intervention. ...
... Overall, studies in the present review were of short duration, with follow-up periods ranging from 3 months to 3 years. In addition, some studies found that intervention effects dissipated over time [22,31 && ], indicating that a better understanding of how program effects can be sustained, either through Internet-based content or delivery, is needed. Future research should aim to evaluate the effectiveness of online prevention programs beyond 3 years, including during the important transition out of secondary school and into early adulthood, a significant life stage characterized by unique challenges and increased risk for substance use. ...
Article
Purpose of review: Alcohol and other drug use are major contributors to the global burden of disease. Prevention is critical and evidence is beginning to support the use of online mediums to prevent alcohol and other drug use and harms among adolescents. This study aims to expand the evidence base by conducting a systematic review of recent universal prevention programs delivered by computers and the Internet. Recent findings: A total of 12 papers reporting outcomes from trials of nine universal online prevention programs were identified. Of the identified interventions, five targeted multiple substances, two focused solely on alcohol, one targeted only cannabis and one primarily addressed smoking. The majority of programs were delivered at school; however one was implemented in a primary care setting. Six programs demonstrated significant, but modest, effects for alcohol and/or other drug use outcomes. Summary: Evidence to support the efficacy of computer and Internet-based prevention programs for alcohol and other drug use and related harms among adolescents is rapidly emerging, demonstrating that online prevention is an area of increasing promise. Further replication work, longer-term trials and attempts to increase the impact are required.
... Specifically, we used the QFP (i.e., from baseline and 12-month follow-up assessments) to measure the number of drinks on a peak drinking day, and the DDQ (i.e., from baseline and 12-month follow-up assessments) to assess the total number of drinks per week. Both questionnaires have been previously used in studies conducted among U.S. young adults, including adolescents, high school and college students (e.g., D'Amico & Fromme, 2000;Doumas, Hausheer, Esp, & Cuffee, 2014; and among Swedish young adults (Gajecki, Berman, Sinadinovic, Rosendahl, & Andersson, 2014). In addition to serving as covariates in our analyses (i.e., peak drinking quantity at baseline), these drinking behavior measures were used to describe the drinking behaviors of the population. ...
... In the present study, three items were added to assess negative consequences related to driving while intoxicated (i.e., "Drove shortly after having more than 1, 2, and 4 drinks"). Previous studies have used the RAPI in samples of young adults (i.e., adolescents, high school and college students) in the United States and in European Nordic countries very similar to Sweden, including Norway and Finland (Arata et al., 2003;Dick, Aliev, Viken, Kaprio, & Rose, 2011;Doumas et al., 2014;Pedersen & Skrondal, 1999). Reliability and validity of this measure have been supported in prior studies conducted in the aforementioned samples in the United States and in Finland (Dick et al., 2011;Martens, Neighbors, Dams-O'Connor, Lee, & Larimer, 2007;White & Labouvie, 1989). ...
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Alcohol use is common among United States and Swedish high school students and is related to negative consequences. Whereas drinking intentions are associated with future drinking behaviors, the use of protective behavioral strategies (PBS) is associated with decreased alcohol-related harm among young adults. The interactive effect of PBS and drinking intentions in predicting alcohol outcomes has not been examined. Further, because most PBS studies have been conducted among U.S. college students, PBS research among other populations is needed. The aims of this study were to evaluate longitudinally (a) the relationships between drinking intentions, PBS and alcohol outcomes, and (b) the moderating roles of drinking intentions and country in these relationships among United States and Swedish high school drinkers. Data were collected at baseline, 6- and 12-month follow-ups on 901 Swedish and 288 U.S. high school drinkers. Drinking intentions were associated with more alcohol use and consequences, and use of certain PBS was related to fewer alcohol-related consequences over time. Additionally, the negative prospective relationship between use of PBS and alcohol use, but not alcohol-related consequences, was moderated by intentions, such that the relationship was stronger among participants endorsing high drinking intentions. Country did not moderate these relationships. These results provide initial support for the generalizability of PBS college research to United States and Swedish high school students and suggest that interventions targeting the use of PBS may be most effective among high school drinkers endorsing high drinking intentions.
... A further improvement for program developers to consider is the importance of transparency and detailed guidance, for those wishing to replicate programs and/or adapt the programs to be applied in other contexts. For example, within this review, e-CHUG was utilized for 10 separate projects by five different lead authors between 2008 and 2020 [37,[58][59][60][61][62][63][64][65][66] and each produced different results and outcomes. Generally, the quality scores increased as time progressed (scores ranged from 3 to 5) but there was no obvious improvement in behavioral outcomes over this time. ...
Article
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Numerous education programs have addressed young peoples’ alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15–24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes.
... and both addressed tobacco use. In a more recent study examining the efficacy of the electronic Check-Up to Go (e-CHUG) among ninth graders, results demonstrated that when compared to a standard school drug education control, the e-CHUG lead to reduced positive alcohol expectancies and positive beliefs about alcohol as well as a reduction in drinking frequency and alcohol-related consequences at three-month follow-up (Doumas, Hausheer, Esp, & Cuffee, 2014). ...
Article
Aims: The purpose of this study was to compare the preliminary efficacy of a computer-assisted intervention (CAI), in which a computer-delivered intervention was immediately followed up with a brief therapist review session, to a therapist-delivered intervention (TDI) for adolescent substance use. Design, Setting, and Participants: Both conditions were examined in a pilot randomized clinical trial. All participants were recruited from a family court in the northeast United States. The sample included a total of 36 adolescents court-referred for an adolescent substance-related offense.Measures: Measures included adolescent alcohol and marijuana-use frequency, quantity, and problems as well as self-efficacy to resist the urge to use.Findings: While no significant time-by-condition differences were noted between the CAI and TDI conditions, significant time effects were found for both the TDI and CAI indicating a decrease in the total number of alcohol- or marijuana-use days over the six-month follow-up period.Conclusions: Given that CAIs are inexpensive, require minimal training, can be implemented with a high degree of fidelity, and are portable when compared to some TDIs, their use for decreasing substance use and related problems, particularly among adolescents with low access to substance-use interventions, seems promising. A fully powered trial of CAI efficacy is indicated.
... 27,28 Most studies of electronic SBI have tested fully automated interventions for adults, with relatively few studies conducted with adolescents. [29][30][31] Substance use interventions that have been adapted for use from adult to youth populations have shown relatively stronger effects when used in college populations. 32 Few studies have examined the use of electronic tools with adolescents in the context of a face-to-face visit. ...
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Background This study aimed to compare care delivery and alcohol and marijuana use for adolescents with risky alcohol use who received a school-based health center (SBHC) visit with and without the Check Yourself tool, an electronic tool that gives motivational feedback on substance use and summarizes results for providers. Methods We conducted a randomized controlled trial with 148 adolescents aged 13–18 who met criteria for moderate- to high- risk alcohol use, recruited from urban SBHCs. Participants were randomized to receive their SBHC visit with ( n = 73) or without ( n = 75) the Check Yourself screening and feedback tool. All SBHC providers received a brief training on motivational interviewing. Results Adolescents who received the Check Yourself tool + SBHC visit reported higher levels of alcohol (67%) and marijuana (73%) counseling from the provider during their visit, compared with those who received a SBHC visit without the tool (40% and 45%, respectively, Ps < .005), and had higher motivation to decrease marijuana use relative to those who did not ( P = .02). Relative to baseline, adolescents in both groups reduced their typical number of drinks of alcohol, maximum number of drinks of alcohol, and hours high on marijuana over time ( Ps < .02) at 2-month follow-up. Conclusion When adolescent patients are given an electronic screening and feedback tool, it can prompt providers to increase counseling of adolescents with substance use risk. Overall, participants who had a visit with a trained provider reported high satisfaction with care and decreased the amount of alcohol use over 2 months, suggesting that SBHCs are an excellent venue for delivery of brief substance use interventions.
... Nevertheless, the 3months follow-up survey made it possible to measure the more proximal intervention effects without major disruptions to the school curriculum and routines. Since Doumas et al. (2014) found that preventive effects found at a 3-months follow-up were difficult to maintain at 6months follow-up survey, it is suggested that school-based prevention programmes could benefit from a booster session to obtain sustainable reductions in alcohol use. ...
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The study aimed to investigate if the school-based social norms intervention The GOOD Life was effective in reducing misperceptions, heavy alcohol use and alcohol-related harms among Danish pupils aged 13–17 years. In total 38 schools were included in a cluster-randomised controlled trial and allocated to either intervention (n = 641) or control group (n = 714) during 2015/2016. Both groups completed an online survey before the intervention and 3 months after baseline. The GOOD Life intervention provided normative feedback tailored for each school-grade using three communication channels: classroom sessions, posters and web application. Outcome measures were overestimation of peers' lifetime binge drinking, binge drinking (5 or more drinks on one occasion) and alcohol-related harms. Intervention effects at follow-up were examined using multilevel logistic regression models. Pupils in the intervention group were less likely to overestimate peers' lifetime binge drinking compared to those in the control group (OR: 0.52, 95%CI: 0.33–0.83) and were less likely to report two or more alcohol-related harms (OR: 0.59, 95%CI: 0.37–0.93). Overall, no significant effect of the intervention was found on binge drinking. However, among pupils stating it would be ok, if they drank more (n = 296), a preventive effect was found on binge drinking four or more times during the last 30 days (OR: 0.37, 95%CI: 0.15–0.95). Additionally, the intervention effect on overestimation was higher among pupils who reported binge drinking at baseline. Receiving the intervention had a positive effect on norm perceptions and alcohol-related harms. We also found that the intervention effect differed by baseline status of alcohol use.
... The growth in the number of people with access to the Internet, almost 40% of the world's population are now online [64], coupled with benefits in terms of increased fidelity, engagement and sustainability, make the Internet a medium of growing importance for AOD prevention. Internet-based programs are advantageous in that trained professionals are not required for their implementation, meaning that intervention delivery is less labour intensive and more feasible [65,66]. Interestingly, in the present review, the Healthy School and Drugs program, which consisted of online lessons for students, was not found to be effective [67,68]. ...
Article
Issues: Alcohol and other drug use among adolescents is a serious concern, and effective prevention is critical. Research indicates that expanding school-based prevention programs to include parenting components could increase prevention outcomes. This paper aims to identify and describe existing combined student- and parent-based programs for the prevention of alcohol and other drug use to evaluate the efficacy of existing programs. Approach: The PsycINFO, Medline, Central Register of Controlled trials and Cochrane databases were searched in April 2015 and additional articles were obtained from reference lists. Studies were included if they evaluated a combined universal intervention for students (aged 11-18 years old) and their parents designed to prevent alcohol and/or other drug use, and were delivered in a school-based setting. Risk of bias was assessed by two independent reviewers. Because of the heterogeneity of the included studies, it was not possible to conduct a meta-analysis and a qualitative description of the studies was provided. Key findings: From a total of 1654 screened papers, 22 research papers met inclusion criteria, which included 13 trials of 10 programs. Of these, nine programs demonstrated significant intervention effects in terms of delaying or reducing adolescent alcohol and/or other drug use in at least one trial. Conclusion: This is the first review of combined student- and parent-based interventions to prevent and reduce alcohol and other drug use. Whilst existing combined student- and parent-based programs have shown promising results, key gaps in the literature have been identified and are discussed in the context of the development of future prevention programs. [Newton NC, Champion KE, Slade T, Chapman C, Stapinski L, Koning I, Tonks Z, Teesson M. A systematic review of combined student- and parent-based programs to prevent alcohol and other drug use among adolescents. Drug Alcohol Rev 2017;00:000-000].
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Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.
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The authors examined the efficacy of a brief, web‐based personalized feedback intervention on reducing alcohol‐related consequences among high school seniors (N = 105) using a group‐randomized controlled design. Results of repeated measures mixed‐models analyses indicated significant intervention effects over time for alcohol‐related consequences at 30‐day and 6‐month follow‐up assessments. Drinking risk status moderated intervention effects such that results were only significant for high‐risk drinkers (i.e., students reporting initiation of heavy episodic drinking at baseline).
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Background: Addiction is one of the most rapidly growing epidemics that currently plagues nations around the world. In the United States, it has cost the government more than US $700 billion a year in terms of health care and other associated costs and is also associated with serious social, physical, and mental consequences. Increasing efforts have been made to tackle this issue at different levels, from primary prevention to rehabilitation across the globe. With the use of digital technology rapidly increasing, an effort to leverage the consumer health information technologies (CHITs) to combat the rising substance abuse epidemic has been underway. CHITs are identified as patient-focused technological platforms aimed to improve patient engagement in health care and aid them in navigating the complex health care system. Objective: This review aimed to provide a holistic and overarching view of the breadth of research on primary prevention of substance abuse using CHIT conducted over nearly past five decades. It also aimed to map out the changing landscape of CHIT over this period. Methods: We conducted a scoping review using the Arksey and O'Malley's modified methodological framework. We searched 4 electronic databases (PubMed, Cochrane, Scopus, and EMBASE). Papers were included if the studies addressed the use of CHIT for primary prevention of substance abuse and were published in English between 1809 and 2018. Studies that did not focus solely on primary prevention or assessed additional comorbid conditions were eliminated. Results: Forty-two papers that met our inclusion criteria were included in the review. These studies were published between 1970 and 2018 and were not restricted by geography, age, race, or sex. The review mapped studies using the most commonly used CHIT platforms for substance abuse prevention from mass media in the 1970s to mobile and social media in 2018. Moreover, 191 studies that were exclusively focused on alcohol prevention were excluded and will be addressed in a separate paper. The studies included had diverse research designs although the majority were randomized controlled trials (RCT) or review papers. Many of the RCTs used interventions based on different behavioral theories such as family interactions, social cognitive theories, and harm-minimization framework. Conclusions: This review found CHIT platforms to be efficacious and cost-effective in the real-world settings. We also observed a gradual shift in the types and use of CHIT platforms over the past few decades and mapped out their progression. In addition, the review detected a shift in consumer preferences and behaviors from face-to-face interactions to technology-based platforms. However, the studies included in this review only focused on the aspect of primary prevention. Future reviews could assess the effectiveness of platforms for secondary prevention and for prevention of substance abuse among comorbid populations.
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Adolescent drinking represents a significant problem in the United States. Although high school juniors and seniors are particularly vulnerable to the negative consequences associated with alcohol use, evidence-based interventions for this age group are limited. The purpose of this article is to introduce a Web-based alcohol intervention with promising evidence as a best practice for a school-based program.
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Background: Commercially available, web-based interventions for the prevention of alcohol use are being adopted for universal use with first-year college students, yet few have received empirical evaluation. Objectives: This randomized controlled trial investigated the effectiveness of a novel, commercially available, personalized web-based alcohol intervention, Alcohol-Wise (version 4.0, 3(rd) Millennium Classrooms), on multiple measures of alcohol consumption, alcohol consequences, alcohol expectancies, academic achievement, and adaptation to college in first-year students. Method: Participants received Alcohol-Wise either prior to first semester or were waitlisted and received the intervention second semester. As longitudinal effectiveness was of interest, follow-up surveys were conducted 10 weeks (n = 76) and 24 weeks (n = 64) following the web-based alcohol intervention. Results: Completion of Alcohol-Wise had effects on academic achievement. Specifically, at the 24 week follow-up, academic achievement was higher in participants who received the intervention first semester of their freshman year as compared to the waitlist control. The incremental rise in heavy episodic drinking during the first semester of college was also reduced in waitlisted participants by Alcohol-Wise administration prior to second semester. Conclusion/Importance: Implications for the timing of web-based alcohol interventions to include administration prior to both first and second semesters of the freshman year are discussed.
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Background: Excessive alcohol use contributes significantly to physical and psychological illness, injury and death, and a wide array of social harm in all age groups. A proven strategy for reducing excessive alcohol consumption levels is to offer a brief conversation-based intervention in primary care settings, but more recent technological innovations have enabled people to interact directly via computer, mobile device or smartphone with digital interventions designed to address problem alcohol consumption. Objectives: To assess the effectiveness and cost-effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol-related problems, or both, in people living in the community, specifically: (i) Are digital interventions more effective and cost-effective than no intervention (or minimal input) controls? (ii) Are digital interventions at least equally effective as face-to-face brief alcohol interventions? (iii) What are the effective component behaviour change techniques (BCTs) of such interventions and their mechanisms of action? (iv) What theories or models have been used in the development and/or evaluation of the intervention? Secondary objectives were (i) to assess whether outcomes differ between trials where the digital intervention targets participants attending health, social care, education or other community-based settings and those where it is offered remotely via the internet or mobile phone platforms; (ii) to specify interventions according to their mode of delivery (e.g. functionality features) and assess the impact of mode of delivery on outcomes. Search methods: We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, ERIC, HTA and Web of Knowledge databases; ClinicalTrials.com and WHO ICTRP trials registers and relevant websites to April 2017. We also checked the reference lists of included trials and relevant systematic reviews. Selection criteria: We included randomised controlled trials (RCTs) that evaluated the effectiveness of digital interventions compared with no intervention or with face-to-face interventions for reducing hazardous or harmful alcohol consumption in people living in the community and reported a measure of alcohol consumption. Data collection and analysis: We used standard methodological procedures expected by The Cochrane Collaboration. Main results: We included 57 studies which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta-analysis, which demonstrated that participants using a digital intervention drank approximately 23 g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate-quality evidence).Fifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate-quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate-quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate-quality evidence).Only five small studies (390 participants) compared digital and face-to-face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI -24.59 to 25.63; low-quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.A median of nine BCTs were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B -43.94, 95% CI -78.59 to -9.30), problem solving (B -48.03, 95% CI -77.79 to -18.27), information about antecedents (B -74.20, 95% CI -117.72 to -30.68), behaviour substitution (B -123.71, 95% CI -184.63 to -62.80) and credible source (B -39.89, 95% CI -72.66 to -7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B -95.12, 95% CI -162.90 to -27.34), problem solving (B -45.92, 95% CI -90.97 to -0.87), and credible source (B -32.09, 95% CI -60.64 to -3.55) were associated with reduced alcohol consumption.The most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51%) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness. Authors' conclusions: There is moderate-quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low-quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face-to-face interventions.The BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.Reporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.
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Purpose of review: Computer-based programs for substance use prevention and intervention among youth are on the ascendancy. Whether delivered by computer per se or by electronic tablet or smartphone, technology-driven programs are harmonious with how young people access information and interact with their worlds. This review examines recent evidence on computer-based programs aimed at substance use among youth, with particular attention to results from randomized trials. Recent findings: Outcome studies of computer-based, substance use-related programs published over the past 5 years reveal mixed results amidst diverse intervention approaches and delivery settings. Many studies are marred by high attrition. Notable in the recent literature is the international nature of technology-driven substance use prevention and intervention programs. With some exceptions, most programs appear to not have been customized for their recipient populations. Though few in number, the highest-quality studies of computer-based programs show positive outcomes in reduced substance use rates. Summary: Based on recent findings, considerable work needs to happen before computer-delivered approaches are a proven means for reducing substance use among youth. Original programs, expressly developed for subgroups of youth, are in short supply. Though controlled designs are becoming commonplace, too many studies of computer-based programs suffer from flaws-including high rates of attrition-that limit the discovery of positive outcomes.
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The eCHECKUP TO GO is identified as a highly effective, low-cost individually-focused alcohol intervention by the NIAAA CollegeAIM guide. The research on the eCHECKUP TO GO for High School is less consistent, suggesting that the program content, originally designed for college students, may need modification for this age group. This randomized controlled study examined the effectiveness of the eCHECKUP TO GO for High School on shifting risk and protective factors for alcohol use targeted by the program at a 4–6 week follow-up. Female high school students in the intervention group reported a reduction in perceptions of peer drinking, beliefs about alcohol, and positive alcohol expectancies, compared to students in the control group. There were no group differences in risk factors for males or in protective behavioral strategies for either males or females. Results indicate the eCHECKUP TO GO for High School may be more effective for females and that program content targeting protective behavioral strategies may need modification for this age group.
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Research indicates that brief Web-based personalized feedback interventions are effective in reducing alcohol use and the negative associated consequences among college students. It is not clear, however, that this is an appropriate strategy for high school students. This study examined high school students' perceptions of a brief Web-based personalized feedback program to assess the appropriateness of this approach for this age group. Results indicated that the majority of students found the program to be user-friendly and to have high utility. Additionally, students reporting alcohol use found the program more useful and indicated that they would be more likely to recommend the program to other students relative to non-drinkers. Findings support the appropriateness of this approach for high school students, and suggest that Web-based personalized feedback may be more positively perceived by students who have initiated drinking.
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This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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To compare the relative influence of risk and protective factors across several domains on adolescent substance use in a large sample of youth. Cross-sectional survey data were collected from students in grades 6, 8, 10, and 12 in Pennsylvania (N = 91,778). Generalized linear mixed models were estimated for each grade level to examine associations among indices of three risk factors (individual, peer, and family) and three protective factors (family, school, and community) and both recent and lifetime substance use. The risk factors were stronger predictors of substance use outcomes compared with the protective factors, regardless of grade level or substance use type. In particular, the individual and peer risk factors were strongly related to lifetime and recent use of cigarettes, alcohol, and marijuana. Among the protective factors, the strongest associations with substance use were found in the community domain. Several age-related differences in the associations were also found, suggesting that family and community factors were more salient among younger adolescents whereas peer and school factors were stronger among older adolescents. These findings provide support for the social development model (SDM), which proposes that adolescent substance use is associated with factors across multiple spheres of influence. Age-related differences in these associations suggest that effective interventions to reduce adolescent substance use may need to emphasize different domains of risk and protective factors at different stages of adolescent development.
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This trial examined the efficacy of teacher-delivered personality-targeted interventions for alcohol-misuse over a 6-month period. This randomized controlled trial randomly allocated participating schools to intervention (n = 11) or control (n = 7) conditions. A total of 2,506 (mean age, 13.7 years) were assessed for elevated levels of personality risk factors for substance misuse: sensation-seeking, impulsivity, anxiety sensitivity, and hopelessness. Six hundred ninety-six adolescents were invited to participate in teacher-delivered personality-targeted interventions, and 463 were assigned to the nontreatment condition. Primary outcomes were drinking, binge-drinking status, quantity by frequency of alcohol use, and drinking-related problems. School delivery of the personality-targeted intervention program was associated with significantly lower drinking rates in high-risk students at 6-month follow-up (odds ratio, 0.6), indicating a 40% decreased risk of alcohol consumption in the intervention group. Receiving an intervention also predicted significantly lower binge-drinking rates in students who reported alcohol use at baseline (odds ratio, 0.45), indicating a 55% decreased risk of binge-drinking in this group compared with controls. In addition, high-risk intervention-school students reported lower quantity by frequency of alcohol use (beta = -.18) and drinking-related problems (beta = -.15) compared with the nontreatment group at follow-up. This trial replicates previous studies reporting the efficacy of personality-targeted interventions and demonstrates that targeted interventions can be successfully delivered by teachers, suggesting potential for this approach as a sustainable school-based prevention model. Clinical trial registration information-Personality-Targeted Interventions for Adolescent Alcohol Misuse, URL: http://www.clinicaltrials.gov, unique identifier: NCT00344474.
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This study tested a computerized gender-specific, parent-involvement intervention program grounded in family interaction theory and aimed at preventing substance use among adolescent girls. Following program delivery and 1 year later, girls randomly assigned to the intervention arm improved more than girls in a control arm on variables associated with reduced risks for substance use, including communication with their mothers, knowledge of family rules about substance use, awareness of parental monitoring of their discretionary time, non-acceptance of peer substance use, problem-solving skills, and ability to refuse peer pressure to use substances. Relative to control-arm girls, those in the intervention arm also reported less 30-day use of alcohol and marijuana and lower intentions to smoke, drink, and take illicit drugs in the future. Girls' mothers in the intervention arm reported greater improvements after the program and relative to control-arm mothers in their communication with their daughters, establishment of family rules about substance use, and monitoring of their daughters' discretionary time. Study findings lend support to the potential of gender-specific, parent-involvement, and computerized approaches to preventing substance use among adolescent girls.
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This study evaluated a gender-specific, computer-mediated intervention program to prevent underage drinking among early adolescent girls. Study participants were adolescent girls and their mothers from New York, New Jersey, and Connecticut. Participants completed pretests online and were randomly divided between intervention and control arms. Intervention-arm girls and their mothers interacted with a computer program aimed to enhance mother-daughter relationships and to teach girls skills for managing conflict, resisting media influences, refusing alcohol and drugs, and correcting peer norms about underage drinking, smoking, and drug use. After intervention, all participants (control and intervention) completed posttest and follow-up measurements. Two months following program delivery and relative to control-arm participants, intervention-arm girls and mothers had improved their mother-daughter communication skills and their perceptions and applications of parental monitoring and rule-setting relative to girls' alcohol use. Also at follow-up, intervention-arm girls had improved their conflict management and alcohol use-refusal skills; reported healthier normative beliefs about underage drinking; demonstrated greater self-efficacy about their ability to avoid underage drinking; reported less alcohol consumption in the past 7 days, 30 days, and year; and expressed lower intentions to drink as adults. Study findings modestly support the viability of a mother-daughter, computer-mediated program to prevent underage drinking among adolescent girls. The data have implications for the further development of gender-specific approaches to combat increases in alcohol and other substance use among American girls.
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To provide a review of the evidence from 3 experimental trials of Project Towards No Drug Abuse (TND), a senior-high-school-based drug abuse prevention program. Theoretical concepts, subjects, designs, hypotheses, findings, and conclusions of these trials are presented. A total of 2,468 high school youth from 42 schools in southern California were surveyed. The Project TND curriculum shows reductions in the use of cigarettes, alcohol, marijuana, hard drugs, weapon carrying, and victimization. Most of these results were replicated across the 3 trials. Project TND is an effective drug and violence prevention program for older teens, at least for one-year follow-up.
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This research evaluated a computer-mediated intervention for preventing drug abuse and violence. Research participants were economically disadvantaged youth, defined as early adolescents from households with family incomes below the Federal poverty line. Based on cognitive-behavioral skills approaches shown effective in past research, computer intervention was compared with conventionally delivered intervention in a pretest-posttest, control group design. Outcome findings revealed that youth assigned to the computer or conventional intervention arms achieved more positive pretest-to-posttest gain scores than youth in the control arm on several variables. These variables were: how youth regarded people who used drugs, strategies for avoiding trouble, and ways for controlling their tempers. One item, the ability to refuse drug offers, favored youth in the conventional intervention arm over those in the computer or control arms. Combined with prior work on computer-delivered interventions, data from this study lend added support to the viability of computer approaches for preventing drug abuse, violence, and other problem behavior among early adolescent youth.
Brief Alcohol Screening and Intervention for College Students (BASICS): A harm reduction approach.
  • Dimeff L.A.
  • Baer J.S.
  • Kivlahan D.R.
  • Marlatt G.A.