College based alcohol misuse intranet assessment and tutor support programme for 16-18 year olds

1. College based alcohol misuse intranet assessment and tutor support programme for 16-18 year olds Debbie Chase, Consultant in Public Health Southampton City Council debbie.chase@southampton.gov.uk University of Southampton, SCC, No Limits, Youth Media, Richard Taunton and Itchen Sixth Form Colleges

2. Acute Accidents Fires/falls/drowning Road Traffic Accident Domestic and street violence Suicide Sexual assault Sexually Transmitted Diseases Chronic Liver cirrhosis Pancreatitis Stroke Cardiomyopathy Depression/epilepsy Deliberate self harm Cancer Oro-pharynx Larynx Oesophagus Liver Breast Colon Some key health consequences

3. Increasing alcohol consumption with age

4. Survey in Sixth Form Colleges 2010 • 2,400 16-18 year olds in Southampton • 23% response (555 students) • 56% female, 13% BME • Median 10 units (IQR 5, 20) 45% drinking at hazardous level • Spirit based drinks most popular • Increased consumption and risk taking with age • Perception peers drinking more and taking more risks

5. Getting SMARTer?A feasibility study of an alcohol misuse screening and brief intervention programme in Sixth Form Colleges • Programme in College A vs no programme in College B • Programme consists of • College Intranet assessment and brief intervention application • Tutor training in brief interventions (with signposting to services) • Approximately 2000 students aged 16-18 years • Academic year 2012/13 (September 12 to July 13) • Baseline and follow up questionnaires on alcohol consumption, related risk and perceptions • Independent and paired data analysis • Nested qualitative study • Outcomes – uptake of training and interventions, use of services • Health related outcomes – change in median weekly alcohol unit consumption and risk associated behaviour

6. Information and support for alcohol misuse within the Colleges Brief Counselling offered by tutors No Limits dropin Specialist alcohol services College A I need some advice about alcohol, where can I go? Intranet application for screening & brief intervention

7. Screening How often? How much on a typical day? How often binge drinking? How often unable to stop? How often need drink to get going? How often feeling of guilt or remorse? How often unable to remember what happened the night before due to drink? Injured as a result of your drinking? Concern expressed? Brief intervention Personalised feedback Guidance on recommended levels and health effects Motivation, coping strategies Alcohol misuse screening and brief intervention

8. Intranet application Chemistry Lab • AUDIT questions • Social norm feedback • Sitting Room area • Links to icons • Information • Unit Calculator • Notice board

9. Autumn term 2012 Summer term 2013 College A Intranet Alcohol screening and brief intervention Baseline Questionnaire Follow up Questionnaire Trained tutors providing brief interventions College B Follow up Questionnaire Baseline Questionnaire

10. Questionnaires Process • Promoted with prize incentive within the College • Dedicated tutor time for completion • College intranet link to web-based questionnaire • Encrypted student ID number – linking baseline and follow-up responses Content • Drinking patterns • AUDIT-C questions • Alcohol related risks have any of the following happened to you after drinking alcohol…over past 6 months? • Perceptions of drinking behaviour • Direction to No Limits

11. Demographics of College populations and questionnaire completion

12. ALCOCHECK • Available on 1 in 3 terminals • 271 students used the application (average 7 times each) Focus groups with students: ‘Most people know the risks already but they choose to do it anyway. So an app’s just going to be...it’s going to be like oh, I’ve got better things to do’ (student 11) ‘‘You can’t give people any more information about alcohol because…it’s just people don’t pay attention to it anymore because it’s just...you are being flooded too much with like information’ (student 5)

13. Tutor training • Over 100 tutors trained on providing alcohol misuse advice and direction to service • Logging of brief interventions proved infeasible Quotes from tutor focus groups: ‘The amount, you know, on the thing is so much smaller than you would imagine and so um, yeah, I was quite shocked that the quantities are really quite small for the units of the alcohol. So that’s something that I have been made aware of more, yeah. (Participant 2)’ ‘And it is because, you know, you can see some form of a difference taking place when you have those conversations, even if it’s not that they are...you know that they are not going to change their ways over night, but if you just get them to even think and reflect on what they have done then that has made a little bit of a difference. (Participant 1)’

14. Alcohol service use

15. All responses

16. Health outcomes

17. Conclusions • Increasing number of students drinking at hazardous level and taking associated risks • Feasible to develop and implement a multi-component intervention • Intranet application favoured by younger students but health related information not popular • Tutor brief intervention training feasible and well accepted, challenge in logging encounters • Use of alcohol services increased in both Colleges • Mixed health benefits, study insufficiently powered to detect true effect

18. Recommendations • Larger study with longer term follow up required • Important young people involved in both development of intervention and study design • Easy method for logging brief intervention interactions needed • Social forum (hosted outside of College) may be a more acceptable internet based intervention • Focus on building mental resilience and risk-based alternatives to alcohol consumption