Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia2Injury Prevention Research Unit, University of Otago, Dunedin, New Zealand.
Injury Prevention Research Unit, University of Otago, Dunedin, New Zealand.
JAMA. 2014 Mar 26;311(12):1218-24. doi: 10.1001/jama.2014.2138.
Unhealthy alcohol use is a leading contributor to the global burden of disease, particularly among young people. Systematic reviews suggest efficacy of web-based alcohol screening and brief intervention and call for effectiveness trials in settings where it could be sustainably delivered.
To evaluate a national web-based alcohol screening and brief intervention program.
DESIGN, SETTING, AND PARTICIPANTS: A multisite, double-blind, parallel-group, individually randomized trial was conducted at 7 New Zealand universities. In April and May of 2010, invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening test were e-mailed to 14,991 students aged 17 to 24 years.
Participants who screened positive (AUDIT-C score ≥4) were randomized to undergo screening alone or to 10 minutes of assessment and feedback (including comparisons with medical guidelines and peer norms) on alcohol expenditure, peak blood alcohol concentration, alcohol dependence, and access to help and information.
A fully automated 5-month follow-up assessment was conducted that measured 6 primary outcomes: consumption per typical occasion, drinking frequency, volume of alcohol consumed, an academic problems score, and whether participants exceeded medical guidelines for acute harm (binge drinking) and chronic harm (heavy drinking). A Bonferroni-corrected significance threshold of .0083 was used to account for the 6 comparisons and a sensitivity analysis was used to assess possible attrition bias.
Of 5135 students screened, 3422 scored 4 or greater and were randomized, and 83% were followed up. There was a significant effect on 1 of the 6 prespecified outcomes. Relative to control participants, those who received intervention consumed less alcohol per typical drinking occasion (median 4 drinks [interquartile range {IQR}, 2-8] vs 5 drinks [IQR 2-8]; rate ratio [RR], 0.93 [99.17% CI, 0.86-1.00]; P = .005) but not less often (RR, 0.95 [99.17% CI, 0.88-1.03]; P = .08) or less overall (RR, 0.95 [99.17% CI, 0.81-1.10]; P = .33). Academic problem scores were not lower (RR, 0.91 [99.17% CI, 0.76-1.08]; P = .14) and effects on the risks of binge drinking (odds ratio [OR], 0.84 [99.17% CI, 0.67-1.05]; P = .04) and heavy drinking (OR, 0.77 [99.17% CI, 0.56-1.05]; P = .03) were not significantly significant. In a sensitivity analysis accounting for attrition, the effect on alcohol per typical drinking occasion was no longer statistically significant.
A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems. There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion.
anzctr.org.au Identifier: ACTRN12610000279022.
不健康的饮酒行为是全球疾病负担的主要原因之一，尤其是在年轻人中。系统评价表明，基于网络的酒精筛查和简短干预措施是有效的，并呼吁在可以可持续提供服务的环境中进行有效性试验。
评估一项全国性的基于网络的酒精筛查和简短干预计划。
设计、地点和参与者：这是一项在新西兰 7 所大学进行的多地点、双盲、平行组、个体随机试验。在 2010 年 4 月和 5 月，向 17 至 24 岁的 14991 名学生发送了包含酒精使用障碍识别测试-消费（AUDIT-C）筛查测试超链接的电子邮件邀请。
筛查阳性（AUDIT-C 评分≥4）的参与者被随机分配接受单独筛查或接受 10 分钟的评估和反馈（包括与医学指南和同伴规范的比较），评估内容包括酒精支出、血液酒精浓度峰值、酒精依赖以及获得帮助和信息的途径。
进行了一项完全自动化的 5 个月随访评估，测量了 6 项主要结果：每次典型饮酒的饮酒量、饮酒频率、饮酒量、学术问题评分，以及参与者是否超过了急性伤害（ binge drinking ）和慢性伤害（ heavy drinking ）的医学指南。使用 Bonferroni 校正的显著性阈值 0.0083 来解释 6 项比较，并使用敏感性分析来评估可能的辍学偏倚。
在 5135 名接受筛查的学生中，有 3422 名学生的评分达到 4 分或更高，并被随机分配，其中 83%的学生接受了随访。在 6 项预先指定的结果中有 1 项存在显著影响。与对照组相比，接受干预的学生每次典型饮酒的饮酒量减少（中位数 4 杯[四分位距 {IQR}，2-8] vs 5 杯[IQR 2-8]；比率比 [RR]，0.93 [99.17% CI，0.86-1.00]；P = 0.005），但饮酒频率（RR，0.95 [99.17% CI，0.88-1.03]；P = 0.08）或总体饮酒量（RR，0.95 [99.17% CI，0.81-1.10]；P = 0.33）没有减少。学术问题评分也没有降低（RR，0.91 [99.17% CI，0.76-1.08]；P = 0.14）， binge drinking （OR，0.84 [99.17% CI，0.67-1.05]；P = 0.04）和 heavy drinking （OR，0.77 [99.17% CI，0.56-1.05]；P = 0.03）的风险也没有显著降低。在一项考虑辍学的敏感性分析中，酒精摄入量的影响不再具有统计学意义。
一项全国性的基于网络的酒精筛查和简短干预计划并没有显著减少饮酒频率或总体饮酒量或学术问题。仍然有可能少量减少每次典型饮酒的饮酒量。
anzctr.org.au 标识符：ACTRN12610000279022。
