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Journal Club

This study evaluates the effectiveness of a web-based alcohol screening and brief intervention program for college students. The results show significant reductions in alcohol consumption and heavy drinking among intervention participants compared to controls.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence January–February 2010 www.aodhealth.org

  2. Featured Article Randomized Controlled Trial of Proactive Web-Based Alcohol Screening and Brief Intervention for University Students Kypri K, et al. Arch Intern Med. 2009;169(16):1508–1514. www.aodhealth.org

  3. Study Objective • To assess the effectiveness of a Web-based alcohol screening and brief intervention program among college students. www.aodhealth.org

  4. Study Design • Two-arm parallel randomized controlled trial. • Australian college students age 17–24 years (N=13000) were invited by letter and follow-up email to complete the Alcohol Use Disorders Identification Test (AUDIT) online. • Of 7237 respondents, 2435 scored positive for hazardous/ harmful drinking (AUDIT score ≥8) and were randomized to either: • 10 minutes of Web-based motivational assessment and personalized feedback, or • screening only. • Follow-up was at 1 and 6 months. Eighty-four percent of participants completed at least 1 online follow-up assess-ment. www.aodhealth.org

  5. Study Design (cont’d) • Primary outcome measures were: • frequency of drinking (range, 0–28 days). • number of standard drinks per drinking occasion. • average weekly alcohol consumption. • Secondary outcome measures were: • prevalence of binge drinking (consuming 4 standard drinks per drinking occasion for women and 6 for men in the last 4 weeks). • prevalence of heavy drinking (consuming >14 standard drinks for women and >28 for men in the last 4 weeks). www.aodhealth.org

  6. Assessing Validity of an Article about Therapy • Are the results valid? • What are the results? • How can I apply the results to patient care? www.aodhealth.org

  7. Are the Results Valid? • Were patients randomized? • Was randomization concealed? • Were patients analyzed in the groups to which they were randomized? • Were patients in the treatment and control groups similar with respect to known prognostic variables? www.aodhealth.org

  8. Are the Results Valid?(cont‘d) • Were patients aware of group allocation? • Were clinicians aware of group allocation? • Were outcome assessors aware of group allocation? • Was follow-up complete? www.aodhealth.org

  9. Were patients randomized? • Yes. • Participants were randomly assigned by Web server software to either the control group (screening only) or to the intervention group. www.aodhealth.org

  10. Was randomization concealed? • Yes. • Participants were blind to the true nature of the study, which was presented as a series of surveys. • Researchers were blind to group assignments. www.aodhealth.org

  11. Were patients analyzed in the groups to which they were randomized? • Yes. • Participants were analyzed in the group to which they were randomized (intention to treat). www.aodhealth.org

  12. Were the patients in the treatment and control groups similar? • Yes. • Demographic characteristics and reported alcohol use were similar between the 2 groups at baseline. www.aodhealth.org

  13. Were patients aware of group allocation? • No. • Patients were not aware of group allocation. www.aodhealth.org

  14. Were clinicians aware of group allocation? • No. • Clinicians were not aware of group allocation. www.aodhealth.org

  15. Were outcome assessors aware of group allocation? • No. • Outcomes were analyzed by computer software. www.aodhealth.org

  16. Was follow-up complete? • No. • Follow-up data were obtained from 962 participants in the intervention group (77%) and 942 patients in the control group (80%) at 1 month. • Follow-up data were obtained from 811 participants in the intervention group (65%) and 767 participants in the control group (65%) at 6 months. www.aodhealth.org

  17. What Are the Results? • How large was the treatment effect? • How precise was the estimate of the treatment effect? www.aodhealth.org

  18. How large was the treatment effect? • At 1 month, compared with controls, intervention participants reported: • lower frequency of drinking (rate ratio [RR], 0.89; 95% CI, 0.83–0.94). • fewer drinks per occasion (RR, 0.93; 95% CI, 0.88–0.98). • lower total alcohol consumption (RR, 0.83; 95% CI, 0.78–0.90). • At 6 months, compared with controls, intervention participants reported: • lower frequency of drinking (RR, 0.91; 95% CI, 0.85–0.97). • no difference in drinks per occasion (RR, 0.96; 95% CI, 0.91–1.02). • lower total consumption (RR, 0.89; 95% CI, 0.82–0.96). www.aodhealth.org

  19. How large was the treatment effect? (cont’d) • Compared with controls, intervention participants reported: • large significant reductions in heavy drinking at 1 month (RR, 0.50; 95% CI, 0.35-0.71) and 6 months (RR, 0.55; 95% CI, 0.38-0.80). • Participants in the intervention group reported less binge drinking at both follow-up assessments, but the differences were not statistically significant. www.aodhealth.org

  20. How precise was the estimate of the treatment effect? • The confidence intervals were narrow for the observed effects. www.aodhealth.org

  21. How Can I Apply the Results to Patient Care? • Were the study patients similar to the patients in my practice? • Were all clinically important outcomes considered? • Are the likely treatment benefits worth the potential harm and costs? www.aodhealth.org

  22. Were the study patients similar to those in my practice? • All patients were Australian undergraduate students age 17–24. • Fifty-five percent were men. • Sixty-five percent lived with a parent or guardian. www.aodhealth.org

  23. Were all clinically important outcomes considered? • Yes. • – A variety of cogent drinking outcomes were • assessed. www.aodhealth.org

  24. Are the likely treatment benefits worth the potential harm and costs? • Potential harms and costs were not assessed in this study. www.aodhealth.org

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