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Omole OB, Pretorius D, Von Pressentin KB. An approach to persons who are not willing to engage in behavioural change. S Afr Fam Pract (2004) 2024; 66:e1-e5. [PMID: 39221727 PMCID: PMC11369572 DOI: 10.4102/safp.v66i1.5874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
With its unique position, primary health care (PHC) can provide health promotion and prevention services, including lifestyle behavioural counselling. Unhealthy lifestyle behaviours are very prevalent among patients attending PHC, with many patients unwilling to change or in the precontemplation stage. While patients in the contemplation stage are better managed using the 5As approach of motivational interviewing counselling, those unwilling or not ready for change necessitate a different approach, such as the 5Rs of motivational interviewing (MI) counselling. The 5Rs MI approach holds promise in motivating unwilling individuals to consider embarking on the journey of behavioural change. The 5Rs approach is not a stand-alone checklist of tasks implemented in isolation but is best integrated within a theoretical behavioural change framework. Of the four health-related behavioural change theoretical frameworks that are frequently used, the transtheoretical stages of the change model are the most used. This continued professional development article provides a summary review of the literature on behavioural change theories as they apply to lifestyle health behaviour change and presents the 5Rs approach as a feasible and practical approach to manage patients who are unwilling to change or in the precontemplation stage. This offers a beacon of hope for improved patient outcomes in a PHC system saddled with high prevalence of modifiable unhealthy lifestyle behaviours.
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Affiliation(s)
- Olufemi B Omole
- Division of Family Medicine, Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg.
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Lemain L, Lever D, Therene-Mouden C, Verdeau R, Barais M, Guillou-Landreat M. Chemsex Among Men Having Sex with Men: A Scoping Review on Management, Support, and Harm Reduction Strategies. JOURNAL OF SEX RESEARCH 2024:1-11. [PMID: 39093301 DOI: 10.1080/00224499.2024.2377592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Chemsex defines the practice of sexual activity under the influence of psychoactive substances, mainly by Men who have Sex with Men (MSM). This activity can be associated with negative health consequences, yet there are no recommendations to guide management of individuals who engage in chemsex. The aim of this scoping review was to identify and describe the existing treatments (pharmacological or not) and risk/harm reduction strategies for MSM who engage in chemsex. This scoping review was performed using PubMed and Embase databases and according to the PRISMA Extension for Scoping Review criteria. Overall, 19 studies were included in the review. Among these studies, four main themes were identified: management and harm reduction strategies, key actors involved in managing MSM who engage in chemsex, perceived barriers to care and the role of pre-exposure prophylaxis, and medical information sought by MSM who engage in chemsex. This scoping review concludes with the need to develop multidisciplinary approaches to improve communication about chemsex, and to design interventional studies that target MSM who engage in chemsex.
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Affiliation(s)
- Loic Lemain
- Addictology Service, University Hospital of Brest, Université de Bretagne occidentale
- ER 7479 SPURBO, University of Western Brittany
| | - Delphine Lever
- Addictology Liaison, University Hospital of Brest, CHU de Brest
| | | | - Romain Verdeau
- Department of General Practice, University of Western Brittany
| | - Marie Barais
- ER 7479 SPURBO, University of Western Brittany
- Department of General Practice, University of Western Brittany
| | - Morgane Guillou-Landreat
- ER 7479 SPURBO, University of Western Brittany
- Addictology Liaison, University Hospital of Brest, CHU de Brest
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Rodrigues AM, Nichol B, Wilson R, Charlton C, Gibson B, Finch T, Haighton C, Maniatopoulos G, Giles E, Harrison D, Orange D, Robson C, Harland J. Mapping regional implementation of 'Making Every Contact Count': mixed-methods evaluation of implementation stage, strategies, barriers and facilitators of implementation. BMJ Open 2024; 14:e084208. [PMID: 39038864 PMCID: PMC11268057 DOI: 10.1136/bmjopen-2024-084208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The Making Every Contact Count (MECC) programme provides training and materials to support public-facing workers to encourage health-promoting behaviour change by using the day-to-day interactions between organisations and individuals. This project aimed to analyse MECC implementation through a comparative analysis of implementation stage, strategies used for implementation and enablers/barriers of the implementation process within a region in England-the North East and North Cumbria (NENC). METHODS A mixed-methods process evaluation was conducted applying normalisation process theory and theoretical domains framework. MECC programme documents were reviewed and mapped against specific criteria (eg, implementation strategies). An online mapping survey was conducted to establish current implementation/delivery of MECC within NENC settings (eg, local government, healthcare and voluntary community sector). Qualitative research, using individual interviews and group discussions, was conducted to establish further understanding of MECC implementation. RESULTS Our findings were informed by reviewing documents (n=5), surveying participants (n=34), interviews (n=18) and group discussions (n=48). Overall, the implementation of MECC within the region was at an early stage, with training mostly delivered between, rather than within, organisations. Qualitative findings highlighted factors that influence stakeholders to implement MECC (eg, organisational goals that were facilitated by MECC implementation, including the prevention agenda), supported resources that facilitate the implementation of MECC (eg, logic models) and enabling factors that promote MECC sustainability across the region (eg, buy-in from leadership and management). CONCLUSIONS The NENC MECC programme is built around regional leadership that supports the implementation process. This process evaluation identified key influences of MECC implementation across the region. We discuss evidence-based recommendation for policy and practice that can be taken forward to develop targeted strategies to support future MECC implementation. For example, a co-ordinated infrastructure and strategy is needed to combat delivery and implementation issues identified.
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Affiliation(s)
- Angela M Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Bethany Nichol
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Rob Wilson
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, UK
| | - Caroline Charlton
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Beckie Gibson
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | | | - Emma Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Deborah Harrison
- Newcastle University Business School, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Orange
- Office for Health Improvement & Disparities, Newcastle upon Tyne, UK
| | - Craig Robson
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jill Harland
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Check DK, Jones KF, Osazuwa-Peters OL, Blalock DV, Marais AD, Merlin JS. Misuse of Prescribed and Nonprescribed Substances Among U.S. Cancer Survivors. J Gen Intern Med 2024:10.1007/s11606-024-08940-2. [PMID: 39028406 DOI: 10.1007/s11606-024-08940-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Substance misuse is common among cancer survivors and can negatively impact cancer outcomes. METHODS We conducted a cross-sectional study using National Survey on Drug Use and Health data for 2015 to 2020. We included adult respondents with a history of solid tumor cancer. We calculated the weighted prevalence and corresponding SEs (both expressed as percentages) of substance (alcohol, opioid, sedative, stimulant, other) misuse for respondents with any history of solid tumor cancer and, in secondary analyses, respondents diagnosed with cancer in the prior 12 months. RESULTS The study included 6,101 respondents with any history of cancer, 1,437 diagnosed in the prior 12 months. Alcohol was the most commonly misused substance. The average prevalence of alcohol misuse was 14.4% (SE 0.60%) across cancer types; it was markedly more common among people with a history or cervical (24.2% [3.0%]) or head and neck cancer (27.4% [7.1%]). The next most common form of substance misuse was opioid misuse (average prevalence: 2.7% [0.25%]). As with alcohol misuse, the prevalence of opioid misuse was higher among those with a lifetime history of cervical cancer (5% [1%]) or head and neck cancer (5% [3%]). Results were generally consistent among cancer survivors diagnosed in the prior 12 months. CONCLUSIONS There is a clear opportunity to address substance misuse-particularly alcohol misuse-among cancer survivors. Such efforts should focus on populations with a high prevalence of substance misuse (e.g., cervical and head and neck cancer survivors) and have strong potential to improve cancer-specific and overall health outcomes.
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Affiliation(s)
- Devon K Check
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, USA.
| | - Katie F Jones
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA
| | - Oyomoare L Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, USA
| | - Dan V Blalock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, USA
| | - Andrea Des Marais
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Jackson K, Baker R, O'Donnell A, Loughran I, Hartrey W, Hulse S. Understanding the challenges of identifying, supporting, and signposting patients with alcohol use disorder in secondary care hospitals, post COVID-19: a qualitative analysis from the North East and North Cumbria, England. BMC Health Serv Res 2024; 24:772. [PMID: 38951799 PMCID: PMC11218181 DOI: 10.1186/s12913-024-11232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/21/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Alcohol-related mortality and morbidity increased during the COVID-19 pandemic in England, with people from lower-socioeconomic groups disproportionately affected. The North East and North Cumbria (NENC) region has high levels of deprivation and the highest rates of alcohol-related harm in England. Consequently, there is an urgent need for the implementation of evidence-based preventative approaches such as identifying people at risk of alcohol harm and providing them with appropriate support. Non-alcohol specialist secondary care clinicians could play a key role in delivering these interventions, but current implementation remains limited. In this study we aimed to explore current practices and challenges around identifying, supporting, and signposting patients with Alcohol Use Disorder (AUD) in secondary care hospitals in the NENC through the accounts of staff in the post COVID-19 context. METHODS Semi-structured qualitative interviews were conducted with 30 non-alcohol specialist staff (10 doctors, 20 nurses) in eight secondary care hospitals across the NENC between June and October 2021. Data were analysed inductively and deductively to identify key codes and themes, with Normalisation Process Theory (NPT) then used to structure the findings. RESULTS Findings were grouped using the NPT domains 'implementation contexts' and 'implementation mechanisms'. The following implementation contexts were identified as key factors limiting the implementation of alcohol prevention work: poverty which has been exacerbated by COVID-19 and the prioritisation of acute presentations (negotiating capacity); structural stigma (strategic intentions); and relational stigma (reframing organisational logics). Implementation mechanisms identified as barriers were: workforce knowledge and skills (cognitive participation); the perception that other departments and roles were better placed to deliver this preventative work than their own (collective action); and the perceived futility and negative feedback cycle (reflexive monitoring). CONCLUSIONS COVID-19, has generated additional challenges to identifying, supporting, and signposting patients with AUD in secondary care hospitals in the NENC. Our interpretation suggests that implementation contexts, in particular structural stigma and growing economic disparity, are the greatest barriers to implementation of evidence-based care in this area. Thus, while some implementation mechanisms can be addressed at a local policy and practice level via improved training and support, system-wide action is needed to enable sustained delivery of preventative alcohol work in these settings.
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Affiliation(s)
| | - Rosie Baker
- North Tees and Hartlepool NHS Hospitals Foundation Trust, Stockton on Tees, UK
| | | | - Iain Loughran
- North East Commissioning Service, Newcastle upon Tyne, UK
| | - William Hartrey
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sarah Hulse
- North East and North Cumbria Integrated Care Board, Newcastle upon Tyne, UK
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Schøler PN, Volke KH, Andréasson S, Rasmussen S, Søndergaard J, Nielsen AS. The identification and treatment of alcohol problems in primary care (iTAPP) study: protocol for a stepped wedge cluster randomized control trial testing the 15-method in a primary care setting. Addict Sci Clin Pract 2024; 19:49. [PMID: 38872214 PMCID: PMC11170864 DOI: 10.1186/s13722-024-00474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The 15-method is a targeted screening and treatment approach for alcohol problems in primary care. The 15-method used in primary care has proven as effective as specialized treatment for mild to moderate alcohol dependence in Sweden. A feasibility study of the 15-method in Danish primary care found the method acceptable and feasible. AIMS To evaluate the effectiveness of the 15-method in a Danish primary care setting in (1) lowering the proportion of patients exceeding the Danish low-risk alcohol consumption limit of ten standard units per week and a maximum of four standard units on a single day for men and women, and (2) increasing the likelihood of alcohol use being addressed during a consultation in general practice. Further, the rate of prescribed pharmacological treatment for alcohol problems (Disulfiram, Naltrexone, Acamprosate, and Nalmefene) will be measured along with the use of the biomarkers Alanine Transaminase and Gamma-Glutamyl Transferase. METHODS Stepped wedge cluster randomized controlled trial in sixteen general practices in the Region of Southern Denmark. Following a three-month baseline, the practices are randomly assigned to launch dates in one of four clusters. General practitioners and nurses receive three hours of training in the 15-method before launch. Patient questionnaires will collect data on alcohol consumption levels among patients affiliated with the practices. The healthcare professionals will register consultations in which alcohol is addressed in their patient filing system. Pharmacological treatment rates and the use of biomarkers will be collected through Danish national registries. The study follows the Medical Research Council's guidelines for developing and evaluating complex interventions. DISCUSSION From the patient's perspective, the 15-method may help identify alcohol-related problems at an earlier stage with flexible treatment offers in a familiar setting. For healthcare professionals, it addresses a traditionally challenging topic by equipping them with concrete tools, communication training, and clear treatment directives. From a societal perspective, primary care holds a unique position to identify hazardous and harmful alcohol use across different age groups, with potential public health and economic benefits through early identification and intervention. TRIAL REGISTRATION Clinicaltrials.gov NCT05916027. Retrospectively registered 22 June 2023.
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Affiliation(s)
- Peter Næsborg Schøler
- The Unit for Clinical Alcohol Research, Department of Clinical Research, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark.
- The Research Unit for General Practice in Odense and Esbjerg, Department of Public Health, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark.
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark.
| | - Kristina Hasselbalch Volke
- The Unit for Clinical Alcohol Research, Department of Clinical Research, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
| | - Sven Andréasson
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sanne Rasmussen
- The Research Unit for General Practice in Odense and Esbjerg, Department of Public Health, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- The Research Unit for General Practice in Odense and Esbjerg, Department of Public Health, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- The Unit for Clinical Alcohol Research, Department of Clinical Research, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- Brain Research - Inter-Disciplinary Guided Excellence, BRIDGE, University of Southern Denmark, Odense, Denmark
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Bayrakdarian ND, Bonar EE, Duguid I, Hellman L, Salino S, Wilkins C, Jannausch M, McKay JR, Staton M, Dollard K, Nahum-Shani I, Walton MA, Blow FC, Coughlin LN. Acceptability and feasibility of a mobile behavioral economic health intervention to reduce alcohol use in adults in rural areas. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100225. [PMID: 38545408 PMCID: PMC10966148 DOI: 10.1016/j.dadr.2024.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 08/27/2024]
Abstract
Background At-risk alcohol use is associated with increased adverse health consequences, yet is undertreated in healthcare settings. People residing in rural areas need improved access to services; however, few interventions are designed to meet the needs of rural populations. Mobile interventions can provide feasible, low-cost, and scalable means for reaching this population and improving health, and behavioral economic approaches are promising. Methods We conducted a pilot randomized controlled trial focused on acceptability and feasibility of a mobile behavioral economic intervention for 75 rural-residing adults with at-risk alcohol use. We recruited participants from a large healthcare system and randomized them to one of four virtually-delivered conditions reflecting behavioral economic approaches: episodic future thinking (EFT), volitional choice (VC), both EFT and VC, or enhanced usual care control (EUC). The intervention included a telephone-delivered induction session followed by two weeks of condition-consistent ecological momentary interventions (EMIs; 2x/day) and ecological momentary assessments (EMAs; 1x/day). Participants completed assessments at baseline, post-intervention, and two-month follow-up, and provided intervention feedback. Results All participants completed the telephone-delivered session and elected to receive EMI messages. Average completion rate of EMAs across conditions was 92.9%. Among participants in active intervention conditions, 89.3% reported the induction session was helpful and 80.0% reported it influenced their future drinking. We also report initial alcohol use outcomes. Discussion The behavioral economic intervention components and trial procedures evaluated here appear to be feasible and acceptable. Next steps include determination of their efficacy to reduce alcohol use and public health harms.
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Affiliation(s)
- Natalie D. Bayrakdarian
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Michigan Innovations in Addiction Care through Research & Education, University of Michigan, Ann Arbor, MI, United States
| | - Isabelle Duguid
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Lauren Hellman
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Salino
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Chelsea Wilkins
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Mary Jannausch
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - James R. McKay
- University of Pennsylvania, Philadelphia, PA, United States
- Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Michele Staton
- Department of Behavioral Science, University of Kentucky, Lexington, KY, United States
| | | | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Michigan Innovations in Addiction Care through Research & Education, University of Michigan, Ann Arbor, MI, United States
| | - Frederic C. Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Lara N. Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Michigan Innovations in Addiction Care through Research & Education, University of Michigan, Ann Arbor, MI, United States
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Cunningham JA, Godinho A, Schell C, Studer J, Wardell JD, Garnett C, Bertholet N. Randomized controlled trial of a smartphone app designed to reduce unhealthy alcohol consumption. Internet Interv 2024; 36:100747. [PMID: 38812955 PMCID: PMC11133919 DOI: 10.1016/j.invent.2024.100747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
Background and aims Unhealthy alcohol use is common and causes tremendous harm. Most people with unhealthy alcohol use will never seek formal alcohol treatment. As an alternative, smartphone apps have been developed as one means to provide help to people concerned about their alcohol use. The aim of this study was to test the efficacy of a smartphone app targeting unhealthy alcohol consumption in a general population sample. Methods Participants were recruited from across Canada using online advertisements. Eligible participants who consented to the trial were asked to download a research-specific version of the app and were provided with a code that unlocked it (a different code for each participant to prevent sharing). Those who entered the code were randomized to one of two different versions of the app: 1) the Full app containing all intervention modules; or 2) the Educational only app, containing only the educational content of the app. Participants were followed-up at 6 months. The primary outcome variable was number of standard drinks in a typical week. Secondary outcome variables were frequency of heavy drinking days and experience of alcohol-related problems. Results A total of 761 participants were randomized to a condition. The follow-up rate was 81 %. A generalized linear mixed model revealed that participants receiving the full app reduced their typical weekly alcohol consumption to a greater extent than participants receiving the educational only app (incidence rate ratio 0.89; 95 % confidence interval 0.80 to 0.98). No significant differences were observed in the secondary outcome variables (p > .05). Discussion and conclusion The results of this trial provide some supportive evidence that smartphone apps can reduce unhealthy alcohol consumption. As this is the second randomized controlled trial demonstrating an impact of this same app (the first one targeted unhealthy alcohol use in university students), increased confidence is placed on the potential effectiveness of the smartphone app employed in the current trial.ClinicalTrials.org number: NCT04745325.
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Affiliation(s)
- John A. Cunningham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | | | - Joseph Studer
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Vaud, Switzerland
- Service of Adult Psychiatry North-West, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Vaud, Switzerland
| | - Jeffrey D. Wardell
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Claire Garnett
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Nicolas Bertholet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Vaud, Switzerland
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Tevik K, Skråstad RB, Benth JŠ, Selbæk G, Bergh S, Eldholm RS, Krokstad S, Helvik AS. Prevalence and change in alcohol consumption in older adults over time, assessed with self-report and Phosphatidylethanol 16:0/18:1 -The HUNT Study. PLoS One 2024; 19:e0304714. [PMID: 38820445 PMCID: PMC11142565 DOI: 10.1371/journal.pone.0304714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/16/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Changes in alcohol consumption may affect older adults' health. We examined prevalence and changes in the alcohol consumption of older women and men (≥65 years) in Norway over a 24-year period. METHODS Data from three population-based health surveys (The Trøndelag Health Study-HUNT2 1995-97, HUNT3 2006-08, HUNT4 2017-19) were used. Alcohol consumption was measured using self-reported measures and an objective measure of alcohol consumption (Phosphatidylethanol 16:0/18:1, PEth). Self-reported lifetime abstinence, former drinking, current drinking, frequent drinking (≥4 times/week), and risk drinking (≥8 units/week) were measured. The PEth concentrations were stratified: <0.03 μmol/l (abstinence/very low level of alcohol consumption); >0.06 μmol/l (indicating >1 unit/day); >0.10 μmol/l (indicating >3 units/day), and >0.30 μmol/l (heavy alcohol consumption). RESULTS In HUNT4, the prevalence of self-reported lifetime abstinence, frequent drinking, and risk drinking was 5.2%, 4.4%, and 5.6%, respectively, while prevalence of PEth <0.03 μmol/l was 68.1% and PEth >0.06 μmol/l was 21.2%. Over the course of the three surveys, the prevalence of self-reported lifetime abstinence decreased, while the prevalence of frequent drinking and risk drinking increased. Men were less often abstainers and more often frequent and risky drinkers than women in all three surveys. Gender differences for abstinence and current drinking reduced with time. From HUNT3 to HUNT4, the prevalence of PEth <0.03 μmol/l decreased, while the prevalence of PEth >0.06 μmol/l increased. Men compared to women, had less often PEth <0.03 μmol/l and more often PEth >0.06 and >0.10 μmol/l in HUNT3 and HUNT4. Women and men ≥75 years were just as likely to have PEth >0.30 μmol/l in HUNT4. The gender differences in PEth concentrations were reduced in HUNT4 among those aged 70-74 years or ≥75 years. CONCLUSION Alcohol consumption has increased among Norwegian older adults over a 24-year period, but at a slower pace during the last decade.
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Affiliation(s)
- Kjerstin Tevik
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ragnhild Bergene Skråstad
- Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Rannveig Sakshaug Eldholm
- Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Anne-Sofie Helvik
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Welfordsson P, Danielsson AK, Björck C, Grzymala-Lubanski B, Lidin M, Löfman IH, Finn SW. Mixed messages? Exposure to reports about alcohol's suggested cardiovascular effects and hazardous alcohol use: a cross-sectional study of patients in cardiology care. BMC Public Health 2024; 24:1302. [PMID: 38741107 DOI: 10.1186/s12889-024-18783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Hazardous alcohol use is a leading risk factor for disability and death, yet observational studies have also reported reduced cardiovascular disease mortality among regular, low-level drinkers. Such findings are refuted by more recent research, yet have received significant media coverage. We aimed to explore: (1) how patients with cardiovascular diseases access health information about moderate drinking and cardiovascular health; (2) the perceived messages these sources convey, and (3) associations with own level of alcohol use. METHODS We conducted a cross-sectional survey of patients in cardiology services at three hospitals in Sweden. The study outcome was hazardous alcohol use, assessed using the AUDIT-C questionnaire and defined as ≥ 3 in women and ≥ 4 in men. The exposure was accessing information sources suggesting that moderate alcohol consumption can be good for the heart, as opposed to accessing information that alcohol is bad for the heart. Health information sources were described using descriptive statistics. Gender, age and education were adjusted for in multiple logistic regression analyses. RESULTS A total of 330 (66.3%) of 498 patients (mean age 70.5 years, 65% males) who had heard that drinking moderately can affect the heart described being exposed to reports that moderate alcohol use can be good for the heart, and 108 (21.7%) met criteria for hazardous alcohol use. Health information sources included newspapers (32.9%), television (29.2%), healthcare staff (13.4%), friends/family (11.8%), social media (8.9%) and websites (3.7%). Participants indicated that most reports (77.9%) conveyed mixed messages about the cardiovascular effects of moderate drinking. Exposure to reports of healthy heart effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use (OR = 1.67, 95%CI = 1.02-2.74). CONCLUSIONS This study suggests that many patients in cardiology care access health information about alcohol from media sources, which convey mixed messages about the cardiovascular effects of alcohol. Exposure to reports that moderate drinking has protective cardiovascular effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use. Findings highlight a need for clear and consistent messages about the health effects of alcohol.
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Affiliation(s)
- Paul Welfordsson
- Department of Global Public Health, Karolinska Institutet, Solna, 113 65, Sweden.
| | | | - Caroline Björck
- Department of Women's and Children's Health, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
| | - Bartosz Grzymala-Lubanski
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Matthias Lidin
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - Ida Haugen Löfman
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Sara Wallhed Finn
- Department of Global Public Health, Karolinska Institutet, Solna, 113 65, Sweden
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Dependency Disorders, Stockholm, Sweden
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11
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Riley-Gibson E, Hall A, Shoesmith A, Wolfenden L, Shelton RC, Doherty E, Pollock E, Booth D, Salloum RG, Laur C, Powell BJ, Kingsland M, Lane C, Hailemariam M, Sutherland R, Nathan N. A systematic review to determine the effect of strategies to sustain chronic disease prevention interventions in clinical and community settings: study protocol. Syst Rev 2024; 13:129. [PMID: 38725053 PMCID: PMC11084058 DOI: 10.1186/s13643-024-02541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced-based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e. physical inactivity, poor diet, harmful alcohol use, and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such, this review will provide important evidence to advance the field of sustainability research. METHODS This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team, data screening and extraction will be performed in duplicate, strategies will be coded using an adapted sustainability-explicit taxonomy, and evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or programme within any of the eligible settings will be included. Article screening, data extraction, risk of bias, and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random-effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include the following: time period, single or multi-strategy, type of setting, and type of intervention. Differences between sub-groups will be statistically compared. DISCUSSION/CONCLUSION This will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022352333.
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Affiliation(s)
- Edward Riley-Gibson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia.
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emma Doherty
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Emma Pollock
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Debbie Booth
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, 76 Grenville StreetOntario, M5S 1B2, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
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12
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Chan PSF, Fang Y, Xie YJ, Wong MCS, Nilsen P, Leung SF, Cheung K, Wang Z, Yeoh EK. Applying the Consolidated Framework for Implementation Research to investigate factors of implementing alcohol screening and brief intervention among primary care physicians and nurses in Hong Kong, China: an exploratory sequential mixed-method study. Implement Sci Commun 2024; 5:52. [PMID: 38711156 PMCID: PMC11071187 DOI: 10.1186/s43058-024-00590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/28/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China. METHODS This was a sequential mixed-method study. In-depth interviews of 21 physicians and 20 nurses working in the primary care settings from the public and private sectors were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential factors not covered by the CFIR. A questionnaire was then developed based on the qualitative findings to investigate factors associated with SBI implementation among 282 physicians and 295 nurses. RESULTS The in-depth interviews identified 22 CFIR constructs that were facilitators or barriers of SBI implementation in Hong Kong. In addition, the stigmatization of alcohol dependence was a barrier and the belief that it was important for people to control the amount of alcohol intake in any situation was mentioned as a facilitator to implement SBI. In the survey, 22% of the participants implemented SBI in the past year. Factors associated with the SBI implementation echoed most of the qualitative findings. Among physicians and nurses in both sectors, they were more likely to implement SBI when perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics but less likely to do so when perceiving SBI implementation to be complicated and of higher cost, and drinking approved by the Chinese culture. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice and better leadership engagement in the public sector, but not in the private sector. Perceiving a stronger need and greater importance to implement SBI were associated with higher likelihood of SBI implementation among physicians, but not among nurses. Perceiving better organizational culture supporting SBI was positively associated with SBI implementation among nurses, but not among physicians. CONCLUSIONS There was a significant gap between SBI evidence and its implementation. Some strategies to improve SBI implementation may be different between physicians and nurses and between those in the public and private sectors. The CFIR is a useful framework for understanding facilitators and barriers of SBI implementation in primary care settings.
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Affiliation(s)
- Paul Shing-Fong Chan
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Martin Chi-Sang Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sau-Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Eng-Kiong Yeoh
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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13
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Nissilä E, Hynninen M, Jalkanen V, Kuitunen A, Bäcklund M, Inkinen O, Hästbacka J. The effectiveness of a brief intervention for intensive care unit patients with hazardous alcohol use: a randomized controlled trial. Crit Care 2024; 28:145. [PMID: 38689346 PMCID: PMC11061909 DOI: 10.1186/s13054-024-04925-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Screening for hazardous alcohol use and performing brief interventions (BIs) are recommended to reduce alcohol-related negative health consequences. We aimed to compare the effectiveness (defined as an at least 10% absolute difference) of BI with usual care in reducing alcohol intake in intensive care unit survivors with history of hazardous alcohol use. METHODS We used Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score to assess history of alcohol use. PATIENTS Emergency admitted adult ICU patients in three Finnish university hospitals, with an AUDIT-C score > 5 (women), or > 6 (men). We randomized consenting eligible patients to receive a BI or treatment as usual (TAU). INTERVENTION BI was delivered by the time of ICU discharge or shortly thereafter in the hospital ward. CONTROLS Control patients received TAU. OUTCOME The primary outcome was self-reported alcohol consumption during the preceding week 6 and 12 months after randomization. Secondary outcomes were the change in AUDIT-C scores from baseline to 6 and 12 months, health-related quality of life, and mortality. The trial was terminated early due to slow recruitment during the pandemic. RESULTS We randomized 234 patients to receive BI (N = 117) or TAU (N = 117). At 6 months, the median alcohol intake in the BI and TAU groups were 6.5 g (interquartile range [IQR] 0-141) and 0 g (0-72), respectively (p = 0.544). At 12 months, it was 24 g (0-146) and 0 g (0-96) in the BI and TAU groups, respectively (p = 0.157). Median change in AUDIT-C from baseline to 6 months was - 1 (- 4 to 0) and 2 (- 6 to 0), (p = 0.144) in the BI and TAU groups, and to 12 months - 3 (- 5 to - 1) and - 4 (- 7 to - 1), respectively (p = 0.187). In total, 4% (n = 5) of patients in the BI group and 11% (n = 13) of patients in the TAU group were abstinent at 6 months, and 10% (n = 12) and 15% (n = 17), respectively, at 12 months. No between-groups difference in mortality emerged. CONCLUSION As underpowered, our study cannot reject or confirm the hypothesis that a single BI early after critical illness is effective in reducing the amount of alcohol consumed compared to TAU. However, a considerable number in both groups reduced their alcohol consumption. TRIAL REGISTRATION ClinicalTrials.gov (NCT03047577).
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Affiliation(s)
- Eliisa Nissilä
- Department of Perioperative and Intensive Care Medicine, Intensive Care Units, Helsinki University Hospital and Helsinki University, Haartmaninkatu 2, PL 340, 00029, Helsinki, Finland.
| | - Marja Hynninen
- Department of Perioperative and Intensive Care Medicine, Intensive Care Units, Helsinki University Hospital and Helsinki University, Haartmaninkatu 2, PL 340, 00029, Helsinki, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Wellbeing District of Pirkanmaa and Tampere University, Tampere, Finland
| | - Anne Kuitunen
- Department of Intensive Care, Tampere University Hospital, Wellbeing District of Pirkanmaa and Tampere University, Tampere, Finland
| | - Minna Bäcklund
- Department of Perioperative and Intensive Care Medicine, Intensive Care Units, Helsinki University Hospital and Helsinki University, Haartmaninkatu 2, PL 340, 00029, Helsinki, Finland
| | - Outi Inkinen
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Wellbeing District of Southwest Finland and University of Turku, Turku, Finland
| | - Johanna Hästbacka
- Department of Perioperative and Intensive Care Medicine, Intensive Care Units, Helsinki University Hospital and Helsinki University, Haartmaninkatu 2, PL 340, 00029, Helsinki, Finland
- Department of Intensive Care, Tampere University Hospital, Wellbeing District of Pirkanmaa and Tampere University, Tampere, Finland
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14
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Côté J, Chicoine G, Vinette B, Auger P, Rouleau G, Fontaine G, Jutras-Aswad D. Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies. J Med Internet Res 2024; 26:e55031. [PMID: 38630515 PMCID: PMC11063887 DOI: 10.2196/55031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/09/2024] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. OBJECTIVE We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. METHODS We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. RESULTS Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by -6.79 days of use in the previous month (95% CI -9.59 to -4.00; P<.001). CONCLUSIONS Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. TRIAL REGISTRATION PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959.
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Affiliation(s)
- José Côté
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
| | - Gabrielle Chicoine
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Billy Vinette
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
| | - Patricia Auger
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
| | - Geneviève Rouleau
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Guillaume Fontaine
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Didier Jutras-Aswad
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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15
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Lemp JM, Pengpid S, Buntup D, Sornpaisarn B, Peltzer K, Geldsetzer P, Probst C. Stakeholder-Informed Solutions To Address Barriers for Alcohol Screening and Brief Intervention in Thai Hypertension Care. JOURNAL OF PREVENTION (2022) 2024; 45:227-236. [PMID: 38148463 DOI: 10.1007/s10935-023-00763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
Premature deaths from NCDs disproportionately affect people in low- and middle-income countries. Since alcohol use is one of the most common causes of reversible hypertension, interventions targeting alcohol use may be a feasible and effective low-cost approach to synergistically reduce the prevalence of harmful drinking and high blood pressure. This study sought to identify key factors in successfully implementing alcohol use screening and brief intervention in hypertension care in Thailand. For this purpose, we surveyed participants (NRound 1 = 91, NRound 2 = 27) from three different groups of Thai stakeholders (policy- and decisionmakers, primary healthcare practitioners, and patients diagnosed with hypertension) in a two-round stakeholder elicitation. In round 1, we identified limited resources, lack of clear guidelines for lifestyle intervention, stigmatization, and inconsistent monitoring of patients' alcohol use as important barriers. In round 2, we sought to elicit solutions for the barriers identified in round 1. While stakeholders emphasized the need for adaptability to existing realities in Thai primary healthcare such as a high workload and limited digitization, they favorably evaluated a digital alcohol assessment tool with integrated, tailored advice for brief intervention as a potential scalable solution. Findings suggest that as one possible route to reduce the NCD burden caused by hypertension in Thailand, primary healthcare services may be enhanced by digital tools that support resource-effective, intuitive, and seamless delivery of alcohol screening and brief intervention.
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Affiliation(s)
- Julia M Lemp
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Doungjai Buntup
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Bundit Sornpaisarn
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Faculty of Public Health, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Chan Zuckerberg Biohub - San Francisco, San Francisco, CA, USA
| | - Charlotte Probst
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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16
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Oldham M, Beard E, Loebenberg G, Dinu L, Angus C, Burton R, Field M, Greaves F, Hickman M, Kaner E, Michie S, Munafò M, Pizzo E, Brown J, Garnett C. Effectiveness of a smartphone app (Drink Less) versus usual digital care for reducing alcohol consumption among increasing-and-higher-risk adult drinkers in the UK: a two-arm, parallel-group, double-blind, randomised controlled trial. EClinicalMedicine 2024; 70:102534. [PMID: 38685934 PMCID: PMC11056393 DOI: 10.1016/j.eclinm.2024.102534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 05/02/2024] Open
Abstract
Background Digital interventions, including apps and websites, can be effective for reducing alcohol consumption. However, many are not evidence- or theory-informed and have not been evaluated. We tested the effectiveness of the Drink Less app for reducing alcohol consumption compared with usual digital care in the UK. Methods In this two-arm, parallel group, double-blind, randomised controlled trial, we enrolled increasing-and-higher-risk drinkers (AUDIT ≥ 8) in the UK, who were motivated to reduce their alcohol consumption and willing to use a digital intervention to do so, via online methods. Participants were randomly assigned (1:1), using an online algorithm, to receive a web link to download the Drink Less app (intervention) or to the NHS alcohol advice webpage (usual digital care). Researchers were masked to group allocation. Participants were followed up at one, three and six months. The primary outcome was self-reported weekly alcohol consumption at six months, adjusting for baseline consumption. The full analytic sample was used in most analyses, though missing data was treated in different ways. The primary, pre-registered intention-to-treat analysis assumed baseline-carried-forwards. Secondary pre-registered analyses also focused on the full analytic sample and used alternatives including multiple imputation and last observation carried forwards. This trial is registered with the ISRCTN registry, ISRCTN64052601. Findings Between 07/13/2020 and 03/29/2022, 5602 people were randomly assigned to the Drink Less app (n = 2788) or comparator (n = 2814) groups. Six-month follow-up rates were 79% and 80%, respectively. The primary pre-registered conservative intention-to-treat approach assuming non-responders were drinking at baseline levels of consumption, found a non-significant greater reduction of 0.98 units in weekly alcohol consumption in the intervention group at 6-month follow-up (95% CI -2.67 to 0.70). The data were insensitive to detect the hypothesised effect (Bayes factor = 1.17). Data were not missing completely at random, with 6-month follow-up rates differing in terms of education, occupation, and income. We therefore conducted the pre-registered sensitivity analysis using multiple imputation, showing that the Drink Less app resulted in a 2.00-unit greater weekly reduction at 6-month follow-up compared with the NHS alcohol advice webpage (95% CI -3.76 to -0.24). Fewer than 0.1% of participants in both arms who responded to one, three or six-month follow-up reported adverse events linked to participation in the trial. Interpretation The Drink Less app may be effective in reducing the alcohol consumption in increasing-and-higher-risk drinkers motivated to reduce their consumption. Funding NIHR Public Health Research Programme.
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Affiliation(s)
- Melissa Oldham
- Department of Behavioural Science and Health, University College London, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, UK
| | - Gemma Loebenberg
- Department of Behavioural Science and Health, University College London, UK
| | - Larisa Dinu
- Department of Behavioural Science and Health, University College London, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robyn Burton
- Office for Health Improvement and Disparities, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Matt Field
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
- NICE (National Institute for Health and Care Excellence), London, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Marcus Munafò
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, UK
| | - Claire Garnett
- Department of Behavioural Science and Health, University College London, UK
- School of Psychological Science, University of Bristol, Bristol, UK
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Wood E, Bright J, Hsu K, Goel N, Ross JWG, Hanson A, Teed R, Poulin G, Denning B, Corace K, Chase C, Halpape K, Lim R, Kealey T, Rehm J. Ligne directrice canadienne pour la prise en charge clinique de la consommation d’alcool à risque élevé et du trouble d’utilisation de l’alcool. CMAJ 2024; 196:E303-E321. [PMID: 38467412 PMCID: PMC10927286 DOI: 10.1503/cmaj.230715-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Contexte: Au Canada, on note que les équipes soignantes et les personnes qui bénéficieraient de soins ciblés connaissent peu les interventions fondées sur des données probantes pour la prise en charge clinique du trouble d’utilisation de l’alcool. Pour combler cette lacune, l’Initiative canadienne de recherche sur l’abus de substances a créé un comité national dans le but d’élaborer une ligne directrice pour la prise en charge clinique de la consommation d’alcool à risque élevé et du trouble lié à la consommation d’alcool. Méthodes: L’élaboration de cette ligne directrice s’est faite selon le processus ADAPTE, et est inspirée par une ligne directrice britanno-colombienne de 2019 pour le trouble lié à la consommation d’alcool. Un comité national de rédaction de la ligne directrice (composé de 36 membres de divers horizons, notamment des universitaires, des médecins, des personnes ayant ou ayant eu des expériences de consommation d’alcool et des personnes s’identifiant comme Autochtones ou Métis) a choisi les thèmes prioritaires, a passé en revue les données probantes et atteint un consensus relatif aux recommandations. Nous avons utilisé l’outil AGREE II (Appraisal of Guidelines for Research and Evaluation Instrument II) et les principes de divulgation des intérêts et de gestion des conflits lors du processus de rédaction des lignes directrices (Principles for Disclosure of Interests and Management of Conflicts in Guidelines) publiés en anglais par le Réseau international des lignes directrices (Guidelines International Network) pour nous assurer que la ligne directrice répondait aux normes internationales de transparence, de qualité élevée et de rigueur méthodologique. Nous avons évalué les recommandations finales à l’aide de l’approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Les recommandations ont fait l’objet d’une revue externe par 13 spécialistes et parties prenantes d’ici et de l’étranger. Recommandations: La ligne directrice comprend 15 recommandations qui concernent le dépistage, le diagnostic, la prise en charge du sevrage et le traitement continu, y compris les interventions psychosociales, les pharmacothérapies et les programmes communautaires. Le comité de rédaction de la ligne directrice a reconnu la nécessité d’insister sur la sous-utilisation des interventions qui pourraient être bénéfiques et sur les modes de prescription et autres pratiques d’usage courant qui ne reposent pas sur des données probantes et pourraient aggraver les effets de la consommation d’alcool. Interprétation: La ligne directrice se veut une ressource à l’intention des médecins, des responsables des orientations politiques et des membres des équipes cliniques et autres, de même que des personnes, des familles et des communautés affectées par la consommation d’alcool. Ces recommandations proposent un cadre fondé sur des données probantes pour alléger le lourd fardeau du trouble d’utilisation de l’alcool au Canada et combler les besoins en matière de traitements et de soins.
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Affiliation(s)
- Evan Wood
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont.
| | - Jessica Bright
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Katrina Hsu
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Nirupa Goel
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Josey W G Ross
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Averill Hanson
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Rand Teed
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Ginette Poulin
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Bryany Denning
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Kim Corace
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Corrina Chase
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Katelyn Halpape
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Ronald Lim
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Tim Kealey
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Jürgen Rehm
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
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Seeballuck C, Dolan S, Kilgariff JK. Getting it right at every stage: Top tips for traumatic dental injury review: Part 2. Br Dent J 2024; 236:428-433. [PMID: 38519659 DOI: 10.1038/s41415-024-7245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Affiliation(s)
- Clement Seeballuck
- Clinical Lecturer in Paediatric Dentistry, Dundee Dental Hospital and Research School, Dundee, DD1 4HR, UK.
| | - Sean Dolan
- Specialty Training Registrar in Restorative Dentistry, Glasgow Dental Hospital and School, Glasgow, G2 3JZ, UK.
| | - Julie K Kilgariff
- Consultant in Endodontics, Dundee Dental Hospital & Research School, Dundee, DD1 4HR, UK.
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Clifford PR, Davis CM, Maisto SA, Stout RL. FRAMES Elements Associated With Alcohol Treatment Research Assessments and Related Behavior Change. J Stud Alcohol Drugs 2024; 85:218-226. [PMID: 37917020 PMCID: PMC10941817 DOI: 10.15288/jsad.22-00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Assessment reactivity research has contributed substantially to our understanding of alcohol treatment research protocols influencing clinical outcomes. The state of the science is such that relatively little is known about how alcohol treatment research participation influences behavior. The purpose of this study was twofold: (a) to determine the distribution of FRAMES elements (i.e., Feedback, personal Responsibility, Advice, a Menu of options, Empathic style of interaction, and support for Self-efficacy) contained in alcohol treatment research assessment interviews; and (b) to examine their association with subsequent alcohol use among a sample of clients presenting for alcohol use disorder treatment. METHOD Audiotaped recordings of participant (n = 189) research assessment interviews were converted to digital recordings and reviewed for FRAMES elements using the FRAMES Checklist Instrument. RESULTS Feedback, personal responsibility, empathic style of interaction, and support for self-efficacy were the more frequently occurring elements across follow-up periods. Alternatively, menu of options and advice occurred infrequently. Feedback and support for self-efficacy predicted subsequent alcohol use, although the association between feedback and alcohol use was unexpectedly positive. CONCLUSIONS As part of the assessment interview process, alcohol treatment research participants receive multiple instances of feedback and support for self-efficacy specific to their alcohol use that are predictive of changes in alcohol use.
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Affiliation(s)
- Patrick R. Clifford
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Christine M. Davis
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | | | - Robert L. Stout
- Pacific Institute for Research and Evaluation, Quantitative Capabilities Collaboration, Beltsville, Maryland
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Stevens MWR, Ivers R, Telenta J, Ali RL. Building workforce capacity to address substance use in primary health care: preliminary results from a mixed-methods pilot program. Aust J Prim Health 2024; 30:NULL. [PMID: 38123163 DOI: 10.1071/py23148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Primary health care is critical to the prevention of alcohol, tobacco and other drug-related harms. Scaling-up screening, brief intervention and referral to treatment (SBIRT) within primary health care can reduce the burden of substance-related diseases, and improve downstream healthcare services. Building knowledge, skills and confidence among general practitioners (GPs), particularly in rural, regional and remote areas, to deliver SBIRT is an essential step. Therefore, this study aimed to pilot test a skills-based training program for GPs designed to build capacity for SBIRT delivery. METHODS This pilot study investigated the acceptability of a structured, educational skills-based training program among GPs, as well as its preliminary effectiveness in inducing changes in confidence to deliver SBIRT, and in increasing knowledge about low-risk alcohol guidance. The training package was designed by experts in addiction medicine and public health, and involved a series of online webinars and in-person workshops at four locations across the South Eastern NSW Primary Healthcare Network catchment. RESULTS A total of 18 GPs registered for the training, with six completing the final webinar. The GPs who completed all sessions demonstrated increases in confidence to deliver SBIRT and alcohol guidance knowledge from baseline. Qualitative feedback found the program acceptable, and GPs were able to successfully implement learnings into practice, and promote to colleagues. CONCLUSIONS The results indicated the potential of this program at a national level, but highlighted the need for a range of additional incentives to encourage uptake and ongoing implementation.
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Affiliation(s)
- Matthew W R Stevens
- Department of Pharmacology, School of Biomedicine, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Joanne Telenta
- COORDINARE - Southeastern NSW PHN, Wollongong, NSW 2500, Australia
| | - Robert L Ali
- Department of Pharmacology, School of Biomedicine, The University of Adelaide, Adelaide, SA 5000, Australia
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21
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Dobashi S, Kawaida K, Saito G, Owaki Y, Yoshimoto H. Gender differences in changes in alcohol consumption achieved by free provision of non-alcoholic beverages: a secondary analysis of a randomized controlled trial. BMC Public Health 2024; 24:150. [PMID: 38200433 PMCID: PMC10782583 DOI: 10.1186/s12889-024-17645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND We recently demonstrated that a 12-week intervention consisting of the provision of free non-alcoholic beverages reduced alcohol consumption in excessive drinkers for 8 weeks after the intervention. However, gender differences in this effect were not explored. Thus, this secondary analysis investigated gender differences in the influence of non-alcoholic beverage provision on alcohol consumption. METHODS Individuals who frequently drank excessively (at least 40 g/day in men and 20 g/day in women) and who were not diagnosed with alcoholism were recruited. Participants were randomized into the intervention or control group by simple randomization using a random number table. In the intervention group, free non-alcoholic beverages were provided once every 4 weeks for 12 weeks (three times in total). The consumption of alcoholic and non-alcoholic beverages was calculated based on a drinking diary submitted with the previous 4 weeks' of data. In this study, we compared the longitudinal changes in alcohol consumption between genders in both groups. RESULTS The provision of non-alcoholic beverages significantly reduced alcohol consumption in both genders; however, significant differences in alcohol consumption between the control and intervention groups were observed only in men. The average alcohol consumption during the intervention fell below the level associated with a high risk of non-communicable diseases in men (32.7 g/day), but not in women (24.8 g/day). Correlation coefficient analysis showed that replacing alcoholic beverages with the provided non-alcoholic beverages resulted in different drinking patterns according to gender. The percent changes in the consumption of alcoholic and non-alcoholic beverages relative to baseline levels did not differ between genders. CONCLUSIONS Our results suggest that the provision of non-alcoholic beverages reduced alcohol consumption irrespective of gender. Of note, providing non-alcoholic beverages might be particularly useful for reducing high-risk alcohol consumption in male excessive drinkers. TRIAL REGISTRATION UMIN UMIN000047949. Registered 4 June 2022.
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Affiliation(s)
- Shohei Dobashi
- Institute of Health and Sports Science, University of Tsukuba, Tsukuba, Japan.
- Research and Development Center for Lifestyle Innovation, University of Tsukuba, 1-2 Kasuga, 305-8550, Tsukuba, Ibaraki, Japan.
| | - Kyoko Kawaida
- Research and Development Center for Lifestyle Innovation, University of Tsukuba, 1-2 Kasuga, 305-8550, Tsukuba, Ibaraki, Japan
| | - Go Saito
- Research and Development Center for Lifestyle Innovation, University of Tsukuba, 1-2 Kasuga, 305-8550, Tsukuba, Ibaraki, Japan
| | - Yukiko Owaki
- Research and Development Center for Lifestyle Innovation, University of Tsukuba, 1-2 Kasuga, 305-8550, Tsukuba, Ibaraki, Japan
| | - Hisashi Yoshimoto
- Research and Development Center for Lifestyle Innovation, University of Tsukuba, 1-2 Kasuga, 305-8550, Tsukuba, Ibaraki, Japan.
- Department of General Medicine and Primary Care, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
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22
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Kock L, Shahab L, Garnett C, Oldham M, Tattan-Birch H, Angus C, Brose L, Brown J. Brief interventions for smoking and alcohol associated with the COVID-19 pandemic: a population survey in England. BMC Public Health 2024; 24:76. [PMID: 38172788 PMCID: PMC10763226 DOI: 10.1186/s12889-023-17559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Following the onset of the COVID-19 pandemic, in March 2020 health care delivery underwent considerable changes. It is unclear how this may have affected the delivery of Brief Interventions (BIs) for smoking and alcohol. We examined the impact of the COVID-19 pandemic on the receipt of BIs for smoking and alcohol in primary care in England and whether certain priority groups (e.g., less advantaged socioeconomic positions, or a history of a mental health condition) were differentially affected. METHODS We used nationally representative data from a monthly cross-sectional survey in England between 03/2014 and 06/2022. Monthly trends in the receipt of BIs for smoking and alcohol were examined using generalised additive models among adults who smoked in the past-year (weighted N = 31,390) and those using alcohol at increasing and higher risk levels (AUDIT score 38, weighted N = 22,386), respectively. Interactions were tested between social grade and the change in slope after the onset of the COVID-19 pandemic, and results reported stratified by social grade. Further logistic regression models assessed whether changes in the of receipt of BIs for smoking and alcohol, respectively, from 12/2016 to 01/2017 and 10/2020 to 06/2022 (or 03/2022 in the case of BIs for alcohol), depended on history of a mental health condition. RESULTS The receipt of smoking BIs declined from an average prevalence of 31.8% (95%CI 29.4-35.0) pre-March 2020 to 24.4% (95%CI 23.5-25.4) post-March 2020. The best-fitting model found that after March 2020 there was a 12-month decline before stabilising by June 2022 in social grade ABC1 at a lower level (~ 20%) and rebounding among social grade C2DE (~ 27%). Receipt of BIs for alcohol was low (overall: 4.1%, 95%CI 3.9-4.4) and the prevalence was similar pre- and post-March 2020. CONCLUSIONS The receipt of BIs for smoking declined following March 2020 but rebounded among priority socioeconomic groups of people who smoked. BIs for alcohol among those who use alcohol at increasing and higher risk levels were low and there was no appreciable change over time. Maintaining higher BI delivery among socioeconomic and mental health priority groups of smokers and increasing and higher risk alcohol users is important to support reductions in smoking and alcohol related inequalities.
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Affiliation(s)
- Loren Kock
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- SPECTRUM Research Consortium, Edinburgh, UK.
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Claire Garnett
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Melissa Oldham
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Colin Angus
- SPECTRUM Research Consortium, Edinburgh, UK
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Leonie Brose
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- SPECTRUM Research Consortium, Edinburgh, UK
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23
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Mahadevan J, Gautam M, Benegal V. Mental health and well-being for the prevention of substance use disorders. Indian J Psychiatry 2024; 66:S272-S282. [PMID: 38445279 PMCID: PMC10911324 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_716_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Jayant Mahadevan
- Department of Psychiatry, Centre for Addiction Medicine, NIMHANS, Bangalore, Karnataka, India E-mail:
| | - Manaswi Gautam
- Consultant Psychiatrist, Gautam Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, NIMHANS, Bangalore, Karnataka, India E-mail:
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Scharer JL, Gass JC, Shepardson RL, Maisto SA, Funderburk JS. Factors Influencing Patient Receptivity to Brief Alcohol Interventions in Primary Care: An Application of Conjoint Analysis. Subst Use Misuse 2023; 59:90-96. [PMID: 37791686 DOI: 10.1080/10826084.2023.2262008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background: Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous alcohol use in primary care settings. However, numerous barriers to implementation of BAIs in routine practice have been identified, including concerns about patient receptivity to BAIs. Despite this being a commonly identified barrier to BAI implementation, little BAI implementation research has focused on patient receptivity. Objectives: This study aimed to identify the treatment preferences of primary care patients who screened positive for hazardous alcohol use and to evaluate factors that may influence patients' receptivity to BAIs delivered in primary care. We conducted a mailed survey of primary care patients (N = 245) who screened positive for hazardous alcohol use on annual screening measures based on electronic medical record data. Patients completed measures assessing treatment preferences and a conjoint analysis questionnaire designed to evaluate the relative importance of three factors (focus of the BAI, tailoring of the BAI, and familiarity with the provider delivering the BAI) for patient receptivity. Results: Conjoint analysis results revealed that familiarity with provider (with patients preferring BAIs delivered by providers they have previously met) was the most important factor in predicting patients' receptivity to BAIs. Additionally, patients preferred to discuss alcohol use in the context of another concern (focus of the BAI) and preferred personalized information tailored based on their specific health concerns (tailoring of the BAI), although these factors were not statistically significant when accounting for familiarity with provider. Conclusions: Findings of the present study have potential to inform future research on implementation of BAIs.
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Affiliation(s)
- Jacob L Scharer
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
| | - Julie C Gass
- VA Center for Integrated Healthcare, VA Western New York Healthcare System (116N), Buffalo, New York, USA
- Department of Psychology, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Robyn L Shepardson
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Stephen A Maisto
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Jennifer S Funderburk
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
- Department of Psychiatry, University of Rochester, Rochester, New York, USA
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25
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Wazir H, Abid M, Essani B, Saeed H, Ahmad Khan M, Nasrullah F, Qadeer U, Khalid A, Varrassi G, Muzammil MA, Maryam A, Syed ARS, Shah AA, Kinger S, Ullah F. Diagnosis and Treatment of Liver Disease: Current Trends and Future Directions. Cureus 2023; 15:e49920. [PMID: 38174191 PMCID: PMC10763979 DOI: 10.7759/cureus.49920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
This narrative review delves into the intricate landscape of liver diseases, providing a comprehensive background of the diverse conditions that afflict this vital organ. Liver diseases, ranging from viral hepatitis and non-alcoholic fatty liver disease (NAFLD) to cirrhosis and hepatocellular carcinoma (HCC), pose significant global health challenges. Understanding these diseases' multifaceted origins and progression is pivotal for developing effective diagnostic and therapeutic strategies. The epidemiology and etiology of liver diseases emphasize the global impact of viral hepatitis, with hepatitis B and C as significant contributors. Concurrently, the rising prevalence of NAFLD, linked to lifestyle factors and metabolic syndrome, underscores the intricate relationship between modern living and liver health. Chronic liver diseases often evolve insidiously, progressing from inflammation to fibrosis and, ultimately, to cirrhosis - a stage characterized by irreversible scarring and compromised function. The heightened risk of HCC in advanced liver disease stages further underscores the urgency of effective diagnostic and therapeutic interventions. The evolving landscape of non-invasive diagnostic tools is explored for their role in enabling early detection and accurate staging of liver diseases. In the realm of treatment, there is a continuous transition toward personalized medicine, customized to suit the unique profiles of individual patients. This shift encompasses a broad spectrum, ranging from personalized pharmacological interventions to lifestyle modifications and surgical options. Delving into innovative therapies, such as gene editing and immunomodulation, offers a glimpse into the promising future directions that have the potential to redefine the landscape of liver disease diagnosis and treatment.
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Affiliation(s)
- Hina Wazir
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Marium Abid
- Medicine, Jinnah Medical and Dental College, Karachi, PAK
| | - Binish Essani
- Medicine, Jinnah Medical and Dental College, Karachi, PAK
| | - Hira Saeed
- Medicine, Federal Medical College, Islamabad, PAK
| | | | - Fnu Nasrullah
- Internal Medicine, Shadab Medical Center, Karachi, PAK
| | - Usama Qadeer
- Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Ayesha Khalid
- Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | | | | | - Areeba Maryam
- Emergency Medicine, Holy Family Hospital, Rawalpindi, PAK
| | | | - Abdul Ahad Shah
- Dermatology, Medical College, Dow University of Health Sciences, Karachi, PAK
| | | | - Farhan Ullah
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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26
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Abstract
Alcohol-related liver disease (ALD) is a major cause of liver-related morbidity and mortality. Epidemiological trends indicate recent and predicted increases in the burden of disease. Disease progression is driven by continued alcohol exposure on a background of genetic predisposition together with environmental cofactors. Most individuals present with advanced disease despite a long history of excessive alcohol consumption and multiple missed opportunities to intervene. Increasing evidence supports the use of non-invasive tests to screen for and identify disease at earlier stages. There is a definite role for public health measures to reduce the overall burden of disease. At an individual level, however, the ability to influence subsequent disease course by modifying alcohol consumption or the underlying pathogenic mechanisms remains limited due to a comparative lack of effective, disease-modifying medical interventions. Abstinence from alcohol is the key determinant of outcome in established ALD and the cornerstone of clinical management. In those with decompensated ALD, liver transplant has a clear role. There is consensus that abstinence from alcohol for an arbitrary period should not be the sole determinant in a decision to transplant. An increasing understanding of the mechanisms by which alcohol causes liver disease in susceptible individuals offers the prospect of new therapeutic targets for disease-modifying drugs. Successful translation will require significant public and private investment in a disease area which has traditionally been underfunded when compared to its overall prevalence.
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Affiliation(s)
- Mark Thursz
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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27
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Krolo-Wicovsky F, Baumann S, Tiede A, Bischof G, John U, Gaertner B, Freyer-Adam J. Do in-person and computer-based brief alcohol interventions reduce tobacco smoking among general hospital patients? Secondary outcomes from a randomized controlled trial. Addict Sci Clin Pract 2023; 18:68. [PMID: 37957757 PMCID: PMC10644412 DOI: 10.1186/s13722-023-00425-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND At-risk alcohol use and tobacco smoking often co-occur. We investigated whether brief alcohol interventions (BAIs) among general hospital patients with at-risk alcohol use may also reduce tobacco smoking over 2 years. We also investigated whether such effects vary by delivery mode; i.e. in-person versus computer-based BAI. METHODS A proactively recruited sample of 961 general hospital patients with at-risk alcohol use aged 18 to 64 years was allocated to three BAI study groups: in-person BAI, computer-based BAI, and assessment only. In-person- and computer-based BAI included motivation-enhancing intervention contacts to reduce alcohol use at baseline and 1 and 3 months later. Follow-ups were conducted after 6, 12, 18 and 24 months. A two-part latent growth model, with self-reported smoking status (current smoking: yes/no) and number of cigarettes in smoking participants as outcomes, was estimated. RESULTS Smoking participants in computer-based BAI smoked fewer cigarettes per day than those assigned to assessment only at month 6 (meannet change = - 0.02; 95% confidence interval = - 0.08-0.00). After 2 years, neither in-person- nor computer-based BAI significantly changed smoking status or number of cigarettes per day in comparison to assessment only or to each other (ps ≥ 0.23). CONCLUSIONS While computer-based BAI also resulted in short-term reductions of number of cigarettes in smoking participants, none of the two BAIs were sufficient to evoke spill-over effects on tobacco smoking over 2 years. For long-term smoking cessation effects, multibehavioural interventions simultaneously targeting tobacco smoking along with at-risk alcohol use may be more effective. TRIAL REGISTRATION NUMBER NCT01291693.
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Affiliation(s)
- Filipa Krolo-Wicovsky
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.
- German Centre for Cardiovascular Research, Partner site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.
| | - Sophie Baumann
- Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany
| | - Anika Tiede
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research, Partner site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ulrich John
- German Centre for Cardiovascular Research, Partner site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany
- Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research, Partner site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany
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Ghosh A, Singh GK, Yadav N, Singh P, Kathiravan S. Brief interventions for alcohol misuse among people living with HIV: a meta-analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:766-786. [PMID: 37921633 DOI: 10.1080/00952990.2023.2248647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/13/2023] [Indexed: 11/04/2023]
Abstract
Background: One-third of people living with HIV (PLHIV) have alcohol misuse or alcohol use disorders which negatively affect course and outcome of HIV.Objectives: The meta-analysis sought to evaluate the effectiveness of brief interventions (BI) on alcohol and HIV outcomes in PLHIV with alcohol misuse.Methods: We included clinical trials published between 1990 and September 2022 on adults with harmful/hazardous alcohol use; only randomized clinical trials (RCTs) were included in the meta-analysis. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinical Trials.Gov, and the World Health Organization's International Clinical Trials Registry Platform databases. Cochrane's risk-of-bias assessment was used.Results: Eighteen studies were included in the narrative synthesis, and a meta-analysis could be performed on 13 studies. Among the included RCTs, seven showed a low risk and two showed a high risk of bias; others showed some concerns. There was no evidence of publication bias. Compared to the control, BI significantly reduces the drinks per drinking day (N = 5, Hedge's g= -0.45, 95%CI = -0.58, -0.32) and the number of heavy drinking days (N = 4, Hedge'sg = -0.81, 95% CI= -0.94, -0.67) between 3-6 months post-intervention. BI also reduces the odds of mortality by 42% (N = 7, OR = 0.58, 95% CI = 0.34, 0.99) in 6-12 months. BI does not change the alcohol risk scores and transition to harmful alcohol use; it does not improve adherence to Anti-Retroviral Therapy and increase viral suppression.Conclusion: Policymakers must introduce and scale up integrated screening and brief intervention services within HIV clinics and primary care.
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Affiliation(s)
- Abhishek Ghosh
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Geetesh K Singh
- Department of Psychology, SCBS, Rashtriya Raksha University (An Institute of National Importance) Lavad, Gandhinagar, India
| | - Nidhi Yadav
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranshu Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjana Kathiravan
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Todd B, Rahm J, Kerley D, Hunt DL. Impact of a Rounding Tool and Clinical Champion on Trauma Patient Screening, Brief Intervention, and Referral to Treatment for Alcohol Use Disorder. J Trauma Nurs 2023; 30:346-352. [PMID: 37937876 DOI: 10.1097/jtn.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Early identification and treatment of alcohol misuse among trauma patients is the standard of care for trauma centers. Yet, trauma programs face significant barriers in adherence to sustained alcohol misuse screening. OBJECTIVE This study aims to evaluate the impact of a rounding tool and clinical champion on screening, brief intervention, and referral to treatment compliance rates for alcohol use disorder in trauma patients. METHODS This is a single-center, retrospective cohort design measuring the impact of a nursing rounding tool and clinical champion on screening, brief intervention, and referral to treatment for alcohol use disorder in trauma patients older than 14 years. Retrospective reviews were conducted over a 5-year period from 2017 to 2021 for all admitted trauma patients as defined by the National Trauma Data Standard. RESULTS More than 5,000 trauma patients were included during the study period. The nurses' rounding tool and clinical champion intervention led to an increase in the alcohol use disorder screening rate from an average of 59% for the first 3 months of the study (May to July 2017) to 95% for the last 3 months of the study (March to May 2021). CONCLUSION Our findings show that a dedicated clinical champion and nurse rounding tool increase compliance for screening, brief intervention, and referral to treatment for alcohol use disorder in trauma patients.
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Affiliation(s)
- Brandon Todd
- Department of Trauma, TriStar Skyline Medical Center, Nashville, Tennessee (Mr Todd, Ms Rahm, and Dr Hunt); and Department of Trauma, Sumner Regional Medical Center, Gallatin, Tennessee (Mr Kerley)
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30
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Schweer-Collins ML, Parr NJ, Saitz R, Tanner-Smith EE. Investigating for Whom Brief Substance Use Interventions Are Most Effective: An Individual Participant Data Meta-analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1459-1482. [PMID: 37133684 PMCID: PMC10678844 DOI: 10.1007/s11121-023-01525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 05/04/2023]
Abstract
Prior research suggests that brief interventions (BIs) for alcohol and other drug use may vary in effectiveness across patient sociodemographic factors. The objective of this individual participant data (IPD) meta-analysis was to explore for whom BIs delivered in general healthcare settings are more or less effective. We examined variability in BI effects by patient age, sex, employment, education, relationship status, and baseline severity of substance use using a two-stage IPD meta-analysis approach. All trials included in a parent aggregate data meta-analysis (k = 116) were invited to contribute IPD, and 29 trials provided patient-level data (12,074 participants). Among females, BIs led to significant reductions in binge alcohol consumption ([Formula: see text] = 0.09, 95% CI [0.03, 0.14]), frequency of alcohol consumption ([Formula: see text] = 0.10, 95% CI [0.03, 0.17]), and alcohol-related consequences ([Formula: see text] = 0.16, 95% CI [0.08, 0.25]), as well as greater substance use treatment utilization ([Formula: see text] = 0.25, 95% CI [0.21, 0.30]). BIs yielded larger reductions in frequency of alcohol consumption at 3-month follow-up for individuals with less than a high school level education ([Formula: see text] = 0.16, 95% CI [0.09, 0.22]). Given evidence demonstrating modest BI effects on alcohol use and mixed or null findings for BI effects on other drug use, BI research should continue to investigate potential drivers of effect magnitude and variation. PROTOCOL REGISTRATION DETAILS: The protocol for this review was pre-registered in PROSPERO #CRD42018086832 and the analysis plan was pre-registered in OSF: osf.io/m48g6.
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Affiliation(s)
- Maria L Schweer-Collins
- Prevention Science Institute, University of Oregon, University of Oregon, 97403-6217, Eugene, OR, USA.
- HEDCO Institute for Evidence-Based Educational Practice, University of Oregon, University of Oregon, 1215, 97403-1215, Eugene, OR, USA.
| | - Nicholas J Parr
- U.S. Department of Veterans Affairs Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, 97239, Portland, OR, USA
| | - Richard Saitz
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Ave, 4th Floor, 02118, Boston, MA, USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, USA
| | - Emily E Tanner-Smith
- Prevention Science Institute, University of Oregon, University of Oregon, 97403-6217, Eugene, OR, USA
- HEDCO Institute for Evidence-Based Educational Practice, University of Oregon, University of Oregon, 1215, 97403-1215, Eugene, OR, USA
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Fletcher K, Moran-Pryor A, Robert-Hendren D. Preliminary Clinical Outcomes of the Hello Sunday Morning Alcohol and Wellbeing Self-Assessment: Feasibility and Acceptability Study. JMIR Form Res 2023; 7:e48245. [PMID: 37874615 PMCID: PMC10630865 DOI: 10.2196/48245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/25/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Alcohol-related injuries and diseases are a leading cause of morbidity and mortality worldwide. Early intervention is essential given the chronic, relapsing nature of alcohol use disorders. There is significant potential for widely accessible web-based screening tools to help individuals determine where they stand in terms of alcohol use and provide support recommendations. Screening and brief interventions (SBIs) provide individuals with a stigma-free opportunity to learn and think about the potential risks of drinking and prompt help-seeking behavior by incorporating behavior change techniques. Furthermore, as excessive alcohol use and mental health problems often occur concurrently, SBIs for both conditions simultaneously can potentially address a critical gap in alcohol and mental health treatment. OBJECTIVE We investigated the feasibility, acceptability, and clinical outcomes of participants completing the Alcohol and Wellbeing Self-assessment (A&WS), a web-based SBI. METHODS The A&WS is freely available on the Hello Sunday Morning website as part of an uncontrolled observational prospective study. Feasibility was assessed based on the number of respondents who commenced and subsequently completed the A&WS. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the A&WS to others. Clinical outcomes were measured in two ways: (1) self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) or psychological distress (Kessler Psychological Distress Scale score) over time and (2) help seeking-both self-reported and immediate web-based help seeking. Preliminary baseline data collected for the first 9 months (March 2022 to December 2022) of the study were reported, including the 3-month follow-up outcomes. RESULTS A total of 17,628 participants commenced the A&WS, and of these, 14,419 (81.8%) completed it. Of those 14,419 who completed the A&WS, 1323 (9.18%) agreed to participate in the follow-up research. Acceptability was high, with 78.46% (1038/1323) reporting high satisfaction levels overall; 95.62% (1265/1323) found the A&WS easy to use and would recommend the tool to others. The 1-, 2-, and 3-month follow-ups were completed by 28.57% (378/1323), 21.09% (279/1323), and 17.61% (233/1323) of the participants, respectively. Significant reductions in the Alcohol Use Disorders Identification Test Consumption subscale (P<.001) and Kessler Psychological Distress Scale scores (P<.001) were observed over the 3-month follow-up period. CONCLUSIONS Our results suggest that the A&WS is a highly feasible and acceptable digital SBI that may support individuals in making changes to their alcohol consumption and improve their psychological well-being. In the absence of a control group, positive clinical outcomes cannot be attributed to the A&WS, which should now be subjected to a randomized controlled trial. This scalable, freely available tool has the potential to reach a large number of adults who might not otherwise access help while complementing the alcohol and mental health treatment ecosystem.
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Affiliation(s)
- Kathryn Fletcher
- Hello Sunday Morning, Sydney, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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Wood E, Bright J, Hsu K, Goel N, Ross JWG, Hanson A, Teed R, Poulin G, Denning B, Corace K, Chase C, Halpape K, Lim R, Kealey T, Rehm J. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ 2023; 195:E1364-E1379. [PMID: 37844924 PMCID: PMC10581718 DOI: 10.1503/cmaj.230715] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND In Canada, low awareness of evidence-based interventions for the clinical management of alcohol use disorder exists among health care providers and people who could benefit from care. To address this gap, the Canadian Research Initiative in Substance Misuse convened a national committee to develop a guideline for the clinical management of high-risk drinking and alcohol use disorder. METHODS Development of this guideline followed the ADAPTE process, building upon the 2019 British Columbia provincial guideline for alcohol use disorder. A national guideline committee (consisting of 36 members with diverse expertise, including academics, clinicians, people with lived and living experiences of alcohol use, and people who self-identified as Indigenous or Métis) selected priority topics, reviewed evidence and reached consensus on the recommendations. We used the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and the Guidelines International Network's Principles for Disclosure of Interests and Management of Conflicts to ensure the guideline met international standards for transparency, high quality and methodological rigour. We rated the final recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool; the recommendations underwent external review by 13 national and international experts and stakeholders. RECOMMENDATIONS The guideline includes 15 recommendations that cover screening, diagnosis, withdrawal management and ongoing treatment, including psychosocial treatment interventions, pharmacotherapies and community-based programs. The guideline committee identified a need to emphasize both underused interventions that may be beneficial and common prescribing and other practice patterns that are not evidence based and that may potentially worsen alcohol use outcomes. INTERPRETATION The guideline is intended to be a resource for physicians, policymakers and other clinical and nonclinical personnel, as well as individuals, families and communities affected by alcohol use. The recommendations seek to provide a framework for addressing a large burden of unmet treatment and care needs for alcohol use disorder within Canada in an evidence-based manner.
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Affiliation(s)
- Evan Wood
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont.
| | - Jessica Bright
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Katrina Hsu
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Nirupa Goel
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Josey W G Ross
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Averill Hanson
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Rand Teed
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Ginette Poulin
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Bryany Denning
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Kim Corace
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Corrina Chase
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Katelyn Halpape
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Ronald Lim
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Tim Kealey
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Jürgen Rehm
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
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King K, Leightley D, Greenberg N, Fear N. The DrinksRation Smartphone App for Modifying Alcohol Use Behaviors in UK Military Service Personnel at Risk of Alcohol-Related Harm: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49918. [PMID: 37831507 PMCID: PMC10612007 DOI: 10.2196/49918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Consumption of alcohol is synonymous with military populations, and studies have shown that serving personnel drink more than age- and sex-matched civilian populations. While ingrained in the military culture, excessive alcohol use is associated with increased rates of disciplinary issues, sickness absence, and loss of productivity, as well as contributing to a burden of acute and chronic health problems. Alcohol brief interventions can reduce alcohol use in civilian populations, but there is a paucity of evidence relating to the effectiveness of similar interventions in military populations. The DrinksRation smartphone app was designed to have a basis in behavior change technique theory and focuses on providing interactive behavioral prompts tailored to a military population. It has previously been shown to be effective in a help-seeking veteran population. OBJECTIVE The primary aim of the Military DrinksRation randomized controlled trial study is to determine whether it is similarly effective in a serving military population. METHODS We compare the effectiveness of the DrinksRation smartphone app with treatment as usual for personnel identified at risk of alcohol-related harm using the Military DrinksRation study that is a 2-arm, single-blind, 1:1 randomized controlled trial of the UK Armed Forces population. It is hypothesized that the DrinksRation app will be more efficacious at reducing alcohol consumption compared to treatment as usual. Recruitment will be predominantly from routine, periodic dental inspections all service personnel regularly undertake, supplemented by recruitment from military-targeted media messaging. The primary outcome is the change in alcohol units consumed per week between baseline and day 84, measured using the timeline follow-back method. Secondary outcome measures are a change in the Alcohol Use Disorders Identification Test score, a change in the quality of life assessment, and a change in drinking motivations and app usability (intervention arm only) between baseline and day 84. A final data collection at 168 days will assess the persistence of any changes over a longer duration. RESULTS The study is expected to open in August 2023 and aims to enroll 728 participants to allow for a study sample size requirement of 218 per arm and a 40% attrition rate. It is expected to take up to 12 months to complete. The results will be published in 2024. CONCLUSIONS The Military DrinksRation study will assess the efficacy of the smartphone app on changing alcohol use behaviors in service personnel. If a positive effect is shown, the UK Defence Medical Services would have an effective, evidence-based tool to use as part of an alcohol management clinical pathway, thereby providing better support for military personnel at risk of harm from alcohol drinking. TRIAL REGISTRATION ISRCTN Registry 42646;. https://doi.org/10.1186/ISRCTN14977034. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49918.
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Affiliation(s)
- Kate King
- Academic Department of Military General Practice, Research & Clinical Innovation, Defence Medical Services, Birmingham, United Kingdom
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel Leightley
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Neil Greenberg
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nicola Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Sturgiss E, Advocat J, Lam T, Nielsen S, Ball L, Gunatillaka N, Martin C, Barton C, Tam CWM, Skouteris H, Mazza D, Russell G. Multifaceted intervention to increase the delivery of alcohol brief interventions in primary care: a mixed-methods process analysis. Br J Gen Pract 2023; 73:e778-e788. [PMID: 37666514 PMCID: PMC10498380 DOI: 10.3399/bjgp.2022.0613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Brief interventions (BIs) are effective for reducing harmful alcohol consumption, but their use in primary care is less frequent than clinically indicated. The REducing AlCohol- related Harm (REACH) project aimed to increase the delivery of BIs in primary care. AIM To assess the effectiveness of the REACH programme in increasing alcohol BIs in general practice and explore the implementation factors that improve or reduce uptake by clinicians. DESIGN AND SETTING This article reports on a sequential, explanatory mixed-methods study of the implementation of the REACH project in six general practice clinics serving low-income communities in Melbourne, Australia. METHOD Time-series analyses were conducted using routinely collected patient records and semi-structured interviews, guided by the consolidated framework for implementation research. RESULTS The six intervention sites significantly increased their rate of recorded alcohol status (56.7% to 60.4%), whereas there was no significant change in the non-intervention practices (344 sites, 55.2% to 56.4%). CONCLUSION REACH resources were seen as useful and acceptable by clinicians and staff. National policies that support the involvement of primary care in alcohol harm reduction helped promote ongoing intervention sustainability.
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Affiliation(s)
- Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Jenny Advocat
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Lauren Ball
- Grad Dip Health Economics and Health Policy, chair of community health and wellbeing, University of Queensland, Brisbane, Australia; Menzies Health Institute Queensland and School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Nilakshi Gunatillaka
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Catherine Martin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Chun Wah Michael Tam
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia; conjoint senior lecturer, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia; Warwick Business School, University of Warwick, Coventry, UK
| | | | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Ebrahimi A, Wiil UK, Baskaran R, Peimankar A, Andersen K, Nielsen AS. AUD-DSS: a decision support system for early detection of patients with alcohol use disorder. BMC Bioinformatics 2023; 24:329. [PMID: 37658294 PMCID: PMC10474761 DOI: 10.1186/s12859-023-05450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) causes significant morbidity, mortality, and injuries. According to reports, approximately 5% of all registered deaths in Denmark could be due to AUD. The problem is compounded by the late identification of patients with AUD, a situation that can cause enormous problems, from psychological to physical to economic problems. Many individuals suffering from AUD never undergo specialist treatment during their addiction due to obstacles such as taboo and the poor performance of current screening tools. Therefore, there is a lack of rapid intervention. This can be mitigated by the early detection of patients with AUD. A clinical decision support system (DSS) powered by machine learning (ML) methods can be used to diagnose patients' AUD status earlier. METHODS This study proposes an effective AUD prediction model (AUDPM), which can be used in a DSS. The proposed model consists of four distinct components: (1) imputation to address missing values using the k-nearest neighbours approach, (2) recursive feature elimination with cross validation to select the most relevant subset of features, (3) a hybrid synthetic minority oversampling technique-edited nearest neighbour approach to remove noise and balance the distribution of the training data, and (4) an ML model for the early detection of patients with AUD. Two data sources, including a questionnaire and electronic health records of 2571 patients, were collected from Odense University Hospital in the Region of Southern Denmark for the AUD-Dataset. Then, the AUD-Dataset was used to build ML models. The results of different ML models, such as support vector machine, K-nearest neighbour, decision tree, random forest, and extreme gradient boosting, were compared. Finally, a combination of all these models in an ensemble learning approach was selected for the AUDPM. RESULTS The results revealed that the proposed ensemble AUDPM outperformed other single models and our previous study results, achieving 0.96, 0.94, 0.95, and 0.97 precision, recall, F1-score, and accuracy, respectively. In addition, we designed and developed an AUD-DSS prototype. CONCLUSION It was shown that our proposed AUDPM achieved high classification performance. In addition, we identified clinical factors related to the early detection of patients with AUD. The designed AUD-DSS is intended to be integrated into the existing Danish health care system to provide novel information to clinical staff if a patient shows signs of harmful alcohol use; in other words, it gives staff a good reason for having a conversation with patients for whom a conversation is relevant.
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Affiliation(s)
- Ali Ebrahimi
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark.
| | - Uffe Kock Wiil
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Ruben Baskaran
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Abdolrahman Peimankar
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Kjeld Andersen
- Unit for Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
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Meade O, O'Brien M, Noone C, Lawless A, McSharry J, Deely H, Hart J, Hayes CB, Keyworth C, Lavoie K, McGowan O, Murphy AW, Murphy PJ, O'Reilly O, Byrne M. Exploring barriers and enablers to the delivery of Making Every Contact Count brief behavioural interventions in Ireland: A cross-sectional survey study. Br J Health Psychol 2023; 28:753-772. [PMID: 36843183 DOI: 10.1111/bjhp.12652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/24/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVES The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by health care professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation. DESIGN Online cross-sectional survey design. METHODS Health care professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict frequency of delivery). Data were visualized using Confidence Interval-Based Estimates of Relevance (CIBER). RESULTS Seventy-nine per cent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R2 = .34), the significant enablers of intervention delivery were 'professional role' (OR = 1.86 [1.10, 3.15]) and 'intentions/goals' (OR = 4.75 [1.97, 11.45]); significant barriers included 'optimistic beliefs about consequences' (OR = .41 [.18, .94]) and 'negative emotions' (OR = .50 [.32, .77]). In the multiple linear regression (R2 = .29), the significant enablers of frequency of MECC delivery were 'intentions/goals' (b = 10.16, p = .02) and professional role (b = 6.72, p = .03); the significant barriers were 'negative emotions' (b = -4.74, p = .04) and 'barriers to prioritisation' (b = -5.00, p = .01). CIBER analyses suggested six predictive domains with substantial room for improvement: 'intentions and goals', 'barriers to prioritisation', 'environmental resources', 'beliefs about capabilities', 'negative emotions' and 'skills'. CONCLUSION Implementation interventions to enhance MECC delivery should target intentions and goals, beliefs about capabilities, negative emotions, environmental resources, skills and barriers to prioritization.
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Affiliation(s)
- Oonagh Meade
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Maria O'Brien
- Office of the Chief Clinical Officer, Health Services Executive, Cork, Ireland
| | - Chris Noone
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Agatha Lawless
- Making Every Contact Count, Health & Wellbeing, Strategy & Research, Health Services Executive, Waterford, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Helen Deely
- Strategy & Research, Healthcare Strategy, Health Service Exectutive, Dublin, Ireland
| | - Jo Hart
- University of Manchester, Manchester, UK
| | - Catherine B Hayes
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | | | - Kim Lavoie
- University of Quebec at Montreal (UQAM) & Montréal Behavioural Medicine Centre, CIUSSS-NIM, Montréal, Canada
| | - Orla McGowan
- Health Service Executive Health and Wellbeing, Dublin, Ireland
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
| | - Patrick J Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, Discipline of General Practice, University of Galway, Galway, Ireland
| | - Orlaith O'Reilly
- Office of the Chief Clinical Officer, Health Services Executive, Kilkenny, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
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Gonçalves PD, Bruzelius E, Levy NS, Segura LE, Livne O, Gutkind S, Boustead AE, Hasin DS, Mauro PM, Silver D, Macinko J, Martins SS. Recreational cannabis legislation and binge drinking in U.S. adolescents and adults. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104085. [PMID: 37329666 PMCID: PMC10527765 DOI: 10.1016/j.drugpo.2023.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Recreational cannabis laws (RCLs) may have spillover effects on binge drinking. Our aims were to investigate binge drinking time trends and the association between RCLs and changes in binge drinking in the United States (U.S.). METHODS We used restricted National Survey on Drug Use and Health data (2008-2019). We examined trends in the prevalence of past-month binge drinking by age groups (12-20, 21-30, 31-40, 41-50, 51+). Then, we compared model-based prevalences of past-month binge drinking before and after RCL by age group, using multi-level logistic regression with state random intercepts, an RCL by age group interaction term, and controlling for state alcohol policies. RESULTS Binge drinking declined overall from 2008 to 2019 among people aged 12-20 (17.54% to 11.08%), and those aged 21-30 (43.66% to 40.22%). However, binge drinking increased among people aged 31+ (ages 31-40: 28.11% to 33.34%, ages 41-50: 25.48% to 28.32%, ages 51+: 13.28% to 16.75%). When investigating model-based prevalences after versus before RCL, binge drinking decreased among people aged 12-20 (prevalence difference=-4.8%; adjusted odds ratio (aOR)=0.77, [95% confidence interval (CI) 0.70-0.85]), and increased among participants aged 31-40 (+1.7%; 1.09[1.01-1.26]), 41-50 (+2.5; 1.15[1.05-1.26]) and 51+ (+1.8%; 1.17[1.06-1.30]). No RCL-related changes were noted in respondents ages 21-30. CONCLUSIONS Implementation of RCLs was associated with increased past-month binge drinking in adults aged 31+ and decreased past-month binge drinking in those aged < 21. As the cannabis legislative landscape continues to change in the U.S., efforts to minimize harms related to binge drinking are critical.
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Affiliation(s)
- Priscila Dib Gonçalves
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Natalie S Levy
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Luis E Segura
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anne E Boustead
- School of Government & Public Policy, University of Arizona, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Diana Silver
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY, USA
| | - James Macinko
- Departments of Community Health Sciences and Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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Liang H, Li J, Zhang N, Wu F, Chen X, Luo H, He W, Liu S, Kang T, Zhang R, Liu Y, Huang Z, Zhang L, Zhao Q, Lv S, Li C, Xie Y, Xu DR. Improving eye care quality through brief verbal intervention on optometry service provider by using unannounced standardized patient with refractive error: study protocol for a randomized controlled trial. BMC Ophthalmol 2023; 23:275. [PMID: 37328796 PMCID: PMC10276370 DOI: 10.1186/s12886-023-03023-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Improper refractive correction can be harmful to eye health, aggravating the burden of vision impairment. During most optometry clinical consultations, practitioner-patient interactions play a key role. Maybe it is feasible for patients themselves to do something to get high-quality optometry. But the present empirical research on the quality improvement of eye care needs to be strengthened. The study aims to test the effect of the brief verbal intervention (BVI) through patients on the quality of optometry service. METHODS This study will take unannounced standardized patient (USP) with refractive error as the core research tool, both in measurement and intervention. The USP case and the checklist will be developed through a standard protocol and assessed for validity and reliability before its full use. USP will be trained to provide standardized responses during optical visits and receive baseline refraction by the skilled study optometrist who will be recruited within each site. A multi-arm parallel-group randomized trial will be used, with one common control and three intervention groups. The study will be performed in four cities, Guangzhou and three cities in Inner Mongolia, China. A total of 480 optometry service providers (OSPs) will be stratified and randomly selected and divided into four groups. The common control group will receive USP usual visits (without intervention), and three intervention groups will separately receive USP visits with three kinds of BVI on the patient side. A detailed outcome evaluation will include the optometry accuracy, optometry process, patient satisfaction, cost information and service time. Descriptive analysis will be performed for the survey results, and the difference in outcomes between interventions and control providers will be compared and statistically tested using generalized linear models (GLMs). DISCUSSION This research will help policymakers understand the current situation and influencing factors of refractive error care quality, and then implement precise policies; at the same time, explore short and easy interventions for patients to improve the quality of optometry service. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200062819. Registered on August 19, 2022.
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Affiliation(s)
- Huijuan Liang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Jiaqi Li
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Nan Zhang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Fang Wu
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Xiaoshan Chen
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Huanyuan Luo
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Wenjun He
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Siyuan Liu
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Ting Kang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Ruotong Zhang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Yujie Liu
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Zizhen Huang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Lanping Zhang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Qing Zhao
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Sensen Lv
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Chunping Li
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Yunyun Xie
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies, Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China.
- Acacia Labs, School of Public Health, Southern Medical University, Guangzhou, China.
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Kilian C, Lemp JM, Probst C. Who benefits from alcohol screening and brief intervention? A mini-review on socioeconomic inequalities with a focus on evidence from the United States. Addict Behav 2023; 145:107765. [PMID: 37315509 DOI: 10.1016/j.addbeh.2023.107765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
Alcohol-attributable mortality contributes to growing health inequalities. Addressing hazardous alcohol use and alcohol use disorders through alcohol screening and brief intervention is therefore a promising public health strategy to improve health equity. In this narrative mini-review, we discuss the extent to which socioeconomic differences exist in the alcohol screening and brief intervention cascade, highlighting the example of the United States. We have searched PubMed to identify and summarize relevant literature addressing socioeconomic inequalities in (a) accessing and affording healthcare, (b) receiving alcohol screenings, and/or (c) receiving brief interventions, focusing predominantly on literature from the Unites States. We found evidence for income-related inequalities in access to healthcare in the United States, partly due to inadequate health insurance coverage for individuals with low socioeconomic status. Alcohol screening coverage appears to be generally very low, as is the probability of receiving a brief intervention when indicated. However, research suggests that the latter is more likely to be provided to individuals with low socioeconomic status than those with high socioeconomic status. Individuals with low socioeconomic status also tend to benefit more from brief interventions, showing greater reductions in their alcohol use. Once access to and affordability of healthcare is ensured and high coverage of alcohol screening is achieved for all, alcohol screening and brief interventions have the potential to enhance health equity by reducing alcohol consumption and alcohol-related health harms.
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Affiliation(s)
- Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Julia M Lemp
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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40
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Ghosh A, Krishnan NC, Kathirvel S, Pillai RR, Basu D, George BB, P V A, Sharma K, Kumar A. Digital screening and brief intervention for alcohol misuse in college students: A pilot, mixed-methods, cluster randomized controlled trial from a low-resourced setting. Asia Pac Psychiatry 2023; 15:e12527. [PMID: 36974919 DOI: 10.1111/appy.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/28/2023] [Accepted: 03/11/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION We examined the feasibility and acceptability of digital screening and brief intervention (d-SBI) for alcohol misuse in college students; the effectiveness of d-SBI was our secondary outcome. We also explored the barriers and facilitators of d-SBI. METHODS The study design is a mixed-methods, pilot, and cluster randomized trial. Five colleges from a northern city in India were randomly allocated to d-SBI and control groups. One hundred and ninety-one students were screened, and 25 (male = 23 and female = 2) participants (age 19.62 ± 2.58 years) fulfilled eligibility. All participants completed follow-up assessments at 3 months. In-depth interviews were done with 11 participants. Alcohol Use Disorder Identification Test (AUDIT) based screening brief intervention was provided on a web portal- or mobile application in the d-SBI group. The control group received digital screening and brief education. Direct questions and usage statistics assessed the measurement acceptability of the intervention. We compared the change in AUDIT scores in the intervention groups over 3 months post-intervention. Thematic analyses of transcripts of interviews were done by inductive coding. RESULTS Most participants reported that d-SBI was user-friendly (80%), advice was appropriate (80%), and perceived it to be useful (72%). Ninety-six percent of users, who logged in, completed screening. There was a significant decrease in AUDIT scores both in d-SBI (p < .001) and control groups (p < .001). Time and group significantly affected the mean AUDIT score, but time × group interaction was non-significant. Thematic analysis revealed six overarching themes. CONCLUSIONS Digital SBI for alcohol misuse is acceptable, feasible, and possibly effective among college students from low-resource settings.
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Affiliation(s)
- Abhishek Ghosh
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India
| | - Narayanan C Krishnan
- Department of Data Science, Indian Institute of Technology (IIT), Palakkad, India
| | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Renjith R Pillai
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India
| | - Debasish Basu
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India
| | - Blessy B George
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India
| | - Aswathy P V
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India
| | - Kshitiz Sharma
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India
| | - Anil Kumar
- Department of Computer Science, Indian Institute of Technology (IIT), Ropar, India
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Greene MC, Kane J, Alto M, Giusto A, Lovero K, Stockton M, McClendon J, Nicholson T, Wainberg ML, Johnson RM, Tol WA. Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries. Cochrane Database Syst Rev 2023; 5:CD013350. [PMID: 37158538 PMCID: PMC10167787 DOI: 10.1002/14651858.cd013350.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Harmful alcohol use is defined as unhealthy alcohol use that results in adverse physical, psychological, social, or societal consequences and is among the leading risk factors for disease, disability and premature mortality globally. The burden of harmful alcohol use is increasing in low- and middle-income countries (LMICs) and there remains a large unmet need for indicated prevention and treatment interventions to reduce harmful alcohol use in these settings. Evidence regarding which interventions are effective and feasible for addressing harmful and other patterns of unhealthy alcohol use in LMICs is limited, which contributes to this gap in services. OBJECTIVES To assess the efficacy and safety of psychosocial and pharmacologic treatment and indicated prevention interventions compared with control conditions (wait list, placebo, no treatment, standard care, or active control condition) aimed at reducing harmful alcohol use in LMICs. SEARCH METHODS We searched for randomized controlled trials (RCTs) indexed in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, the Cochrane Clinical Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, Embase, PsycINFO, CINAHL, and the Latin American and Caribbean Health Sciences Literature (LILACS) through 12 December 2021. We searched clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, Web of Science, and Opengrey database to identify unpublished or ongoing studies. We searched the reference lists of included studies and relevant review articles for eligible studies. SELECTION CRITERIA All RCTs comparing an indicated prevention or treatment intervention (pharmacologic or psychosocial) versus a control condition for people with harmful alcohol use in LMICs were included. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 66 RCTs with 17,626 participants. Sixty-two of these trials contributed to the meta-analysis. Sixty-three studies were conducted in middle-income countries (MICs), and the remaining three studies were conducted in low-income countries (LICs). Twenty-five trials exclusively enrolled participants with alcohol use disorder. The remaining 51 trials enrolled participants with harmful alcohol use, some of which included both cases of alcohol use disorder and people reporting hazardous alcohol use patterns that did not meet criteria for disorder. Fifty-two RCTs assessed the efficacy of psychosocial interventions; 27 were brief interventions primarily based on motivational interviewing and were compared to brief advice, information, or assessment only. We are uncertain whether a reduction in harmful alcohol use is attributable to brief interventions given the high levels of heterogeneity among included studies (Studies reporting continuous outcomes: Tau² = 0.15, Q =139.64, df =16, P<.001, I² = 89%, 3913 participants, 17 trials, very low certainty; Studies reporting dichotomous outcomes: Tau²=0.18, Q=58.26, df=3, P<.001, I² =95%, 1349 participants, 4 trials, very low certainty). The other types of psychosocial interventions included a range of therapeutic approaches such as behavioral risk reduction, cognitive-behavioral therapy, contingency management, rational emotive therapy, and relapse prevention. These interventions were most commonly compared to usual care involving varying combinations of psychoeducation, counseling, and pharmacotherapy. We are uncertain whether a reduction in harmful alcohol use is attributable to psychosocial treatments due to high levels of heterogeneity among included studies (Heterogeneity: Tau² = 1.15; Q = 444.32, df = 11, P<.001; I²=98%, 2106 participants, 12 trials, very low certainty). Eight trials compared combined pharmacologic and psychosocial interventions with placebo, psychosocial intervention alone, or another pharmacologic treatment. The active pharmacologic study conditions included disulfiram, naltrexone, ondansetron, or topiramate. The psychosocial components of these interventions included counseling, encouragement to attend Alcoholics Anonymous, motivational interviewing, brief cognitive-behavioral therapy, or other psychotherapy (not specified). Analysis of studies comparing a combined pharmacologic and psychosocial intervention to psychosocial intervention alone found that the combined approach may be associated with a greater reduction in harmful alcohol use (standardized mean difference (standardized mean difference (SMD))=-0.43, 95% confidence interval (CI): -0.61 to -0.24; 475 participants; 4 trials; low certainty). Four trials compared pharmacologic intervention alone with placebo and three with another pharmacotherapy. Drugs assessed were: acamprosate, amitriptyline, baclofen disulfiram, gabapentin, mirtazapine, and naltrexone. None of these trials evaluated the primary clinical outcome of interest, harmful alcohol use. Thirty-one trials reported rates of retention in the intervention. Meta-analyses revealed that rates of retention between study conditions did not differ in any of the comparisons (pharmacologic risk ratio (RR) = 1.13, 95% CI: 0.89 to 1.44, 247 participants, 3 trials, low certainty; pharmacologic in addition to psychosocial intervention: RR = 1.15, 95% CI: 0.95 to 1.40, 363 participants, 3 trials, moderate certainty). Due to high levels of heterogeneity, we did not calculate pooled estimates comparing retention in brief (Heterogeneity: Tau² = 0.00; Q = 172.59, df = 11, P<.001; I2 = 94%; 5380 participants; 12 trials, very low certainty) or other psychosocial interventions (Heterogeneity: Tau² = 0.01; Q = 34.07, df = 8, P<.001; I2 = 77%; 1664 participants; 9 trials, very low certainty). Two pharmacologic trials and three combined pharmacologic and psychosocial trials reported on side effects. These studies found more side effects attributable to amitriptyline relative to mirtazapine, naltrexone and topiramate relative to placebo, yet no differences in side effects between placebo and either acamprosate or ondansetron. Across all intervention types there was substantial risk of bias. Primary threats to validity included lack of blinding and differential/high rates of attrition. AUTHORS' CONCLUSIONS In LMICs there is low-certainty evidence supporting the efficacy of combined psychosocial and pharmacologic interventions on reducing harmful alcohol use relative to psychosocial interventions alone. There is insufficient evidence to determine the efficacy of pharmacologic or psychosocial interventions on reducing harmful alcohol use largely due to the substantial heterogeneity in outcomes, comparisons, and interventions that precluded pooling of these data in meta-analyses. The majority of studies are brief interventions, primarily among men, and using measures that have not been validated in the target population. Confidence in these results is reduced by the risk of bias and significant heterogeneity among studies as well as the heterogeneity of results on different outcome measures within studies. More evidence on the efficacy of pharmacologic interventions, specific types of psychosocial interventions are needed to increase the certainty of these results.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle Alto
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Melissa Stockton
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Jasmine McClendon
- Department of Psychiatry, UC Davis Medical Center, Sacramento, CALIFORNIA, USA
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, USA
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Brem MJ, Shorey RC, Ramsey SE, Stuart GL. Randomized Clinical Trial of a Brief Alcohol Intervention as an Adjunct to Batterer Intervention for Women Arrested for Domestic Violence. INTERVENCION PSICOSOCIAL 2023; 32:79-88. [PMID: 37383647 PMCID: PMC10294462 DOI: 10.5093/pi2023a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/10/2023] [Indexed: 06/30/2023]
Abstract
Despite a rise in women being arrested for domestic violence and court-ordered to batterer intervention, batterer interventions remain limited in their ability to address women's treatment needs. Alcohol use is an important intervention target: one-third of women in batterer interventions have an alcohol-related diagnosis, half engage in at-risk drinking, and alcohol use contributes to intimate partner violence (IPV) and batterer intervention dropout. Research has not evaluated whether adding an alcohol intervention to batterer intervention improves women's alcohol use and IPV outcomes. We randomized 209 women (79.9% white) in Rhode Island to receive the state-mandated batterer intervention program alone or the batterer intervention program plus a brief alcohol intervention. Alcohol use (percentage of days abstinent from alcohol [PDAA], number of drinks per drinking day [DPDD], percentage of heavy drinking days [PHDD], percentage of days abstinent from alcohol and drugs [PDAAD]), and IPV perpetration and victimization frequency (psychological, physical, and sexual IPV, injury) data were collected at baseline and 3-, 6-, and 12-month follow-up. Multilevel modeling revealed that, relative to the batterer intervention alone, women who received the brief alcohol intervention reported a higher PDAA and PDAAD, fewer DPDD, and a lower PHDD across all follow-up assessments. Women who received the brief alcohol intervention perpetrated less physical IPV and experienced less injury than did women who only received the batterer intervention. For physical IPV, these differences became more pronounced over time. No other group differences or group x time interactions emerged. Adding an alcohol intervention may improve batterer intervention outcomes for women arrested for domestic violence.
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Affiliation(s)
- Meagan J. Brem
- Virginia Polytechnic Institute and State UniversityBacksburgUSAVirginia Polytechnic Institute and State University, Backsburg, USA;
| | - Ryan C. Shorey
- University of Wisconsin-MilwaukeeUSAUniversity of Wisconsin-Milwaukee, USA
| | - Susan E. Ramsey
- Alpert Medical School of Brown UniversityRhode Island HospitalProvidenceUSAAlpert Medical School of Brown University and Rhode Island Hospital, Providence, USA;
| | - Gregory L. Stuart
- University of Tennessee-KnoxvilleUSAUniversity of Tennessee-Knoxville, USA
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Vaca FE, Dziura J, Abujarad F, Pantalon M, Hsiao A, Reynolds J, Maciejewski KR, Field CA, D’Onofrio G. Use of an Automated Bilingual Digital Health Tool to Reduce Unhealthy Alcohol Use Among Latino Emergency Department Patients: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2314848. [PMID: 37219901 PMCID: PMC10208138 DOI: 10.1001/jamanetworkopen.2023.14848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
Importance Alcohol use disorders have a high disease burden among US Latino groups. In this population, health disparities persist, and high-risk drinking has been increasing. Effective bilingual and culturally adapted brief interventions are needed to identify and reduce disease burden. Objective To compare the effectiveness of an automated bilingual computerized alcohol screening and intervention (AB-CASI) digital health tool with standard care for the reduction of alcohol consumption among US adult Latino emergency department (ED) patients with unhealthy drinking. Design, Setting, and Participants This bilingual unblinded parallel-group randomized clinical trial evaluated the effectiveness of AB-CASI vs standard care among 840 self-identified adult Latino ED patients with unhealthy drinking (representing the full spectrum of unhealthy drinking). The study was conducted from October 29, 2014, to May 1, 2020, at the ED of a large urban community tertiary care center in the northeastern US that was verified as a level II trauma center by the American College of Surgeons. Data were analyzed from May 14, 2020, to November 24, 2020. Intervention Patients randomized to the intervention group received AB-CASI, which included alcohol screening and a structured interactive brief negotiated interview in their preferred language (English or Spanish) while in the ED. Patients randomized to the standard care group received standard emergency medical care, including an informational sheet with recommended primary care follow-up. Main Outcomes and Measures The primary outcome was the self-reported number of binge drinking episodes within the last 28 days, assessed by the timeline followback method at 12 months after randomization. Results Among 840 self-identified adult Latino ED patients (mean [SD] age, 36.2 [11.2] years; 433 [51.5%] male; and 697 [83.0%] of Puerto Rican descent), 418 were randomized to the AB-CASI group and 422 to the standard care group. A total of 443 patients (52.7%) chose Spanish as their preferred language at enrollment. At 12 months, the number of binge drinking episodes within the last 28 days was significantly lower in those receiving AB-CASI (3.2; 95% CI, 2.7-3.8) vs standard care (4.0; 95% CI, 3.4-4.7; relative difference [RD], 0.79; 95% CI, 0.64-0.99). Alcohol-related adverse health behaviors and consequences were similar between groups. The effect of AB-CASI was modified by age; at 12 months, the relative reduction in the number of binge drinking episodes within the last 28 days in the AB-CASI vs standard care group was 30% in participants older than 25 years (RD, 0.70; 95% CI, 0.54-0.89) compared with an increase of 40% in participants 25 years or younger (RD, 1.40; 95% CI, 0.85-2.31; P = .01 for interaction). Conclusions and Relevance In this study, US adult Latino ED patients who received AB-CASI had a significant reduction in the number of binge drinking episodes within the last 28 days at 12 months after randomization. These findings suggest that AB-CASI is a viable brief intervention that overcomes known procedural barriers to ED screening, brief intervention, and referral to treatment and directly addresses alcohol-related health disparities. Trial Registration ClinicalTrials.gov Identifier: NCT02247388.
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Affiliation(s)
- Federico E. Vaca
- Department of Emergency Medicine, University of California Irvine School of Medicine, Orange
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Fuad Abujarad
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michael Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Allen Hsiao
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jesse Reynolds
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | | | - Craig A. Field
- Latino Health Disparities Research, University of Texas at El Paso, El Paso
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Davy-Mendez T, Sarovar V, Levine-Hall T, Lea AN, Sterling SA, Chi FW, Palzes VA, Luu MN, Flamm JA, Hare CB, Williams EC, Bryant KJ, Weisner CM, Silverberg MJ, Satre DD. Characterizing Unhealthy Alcohol Use Patterns and Their Association with Alcohol Use Reduction and Alcohol Use Disorder During Follow-Up in HIV Care. AIDS Behav 2023; 27:1380-1391. [PMID: 36169779 PMCID: PMC10043049 DOI: 10.1007/s10461-022-03873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
Outcomes of PWH with unhealthy alcohol use, such as alcohol use reduction or progression to AUD, are not well-known and may differ by baseline patterns of unhealthy alcohol use. Among 1299 PWH screening positive for NIAAA-defined unhealthy alcohol use in Kaiser Permanente Northern California, 2013-2017, we compared 2-year probabilities of reduction to low-risk/no alcohol use and rates of new AUD diagnoses by baseline use patterns, categorized as exceeding: only daily limits (72% of included PWH), only weekly limits (17%), or both (11%), based on NIAAA recommendations. Overall, 73.2% (95% CI 70.5-75.9%) of re-screened PWH reduced to low-risk/no alcohol use over 2 years, and there were 3.1 (95% CI 2.5-3.8%) new AUD diagnoses per 100 person-years. Compared with PWH only exceeding daily limits at baseline, those only exceeding weekly limits and those exceeding both limits were less likely to reduce and likelier to be diagnosed with AUD during follow-up. PWH exceeding weekly drinking limits, with or without exceeding daily limits, may have a potential need for targeted interventions to address unhealthy alcohol use.
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Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd., CB #7030, Chapel Hill, NC, 27599, USA.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mitchell N Luu
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jason A Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento, CA, USA
| | - C Bradley Hare
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Emily C Williams
- Center of Innovation for Veteran Centered and Value-Driven Care, Veterans Affairs Puget Sound, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, USA
| | - Constance M Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Adams EJ, Morris L, Marshall G, Coffey F, Miller PD, Blake H. Effectiveness and implementation of interventions for health promotion in urgent and emergency care settings: an umbrella review. BMC Emerg Med 2023; 23:41. [PMID: 37024777 PMCID: PMC10080902 DOI: 10.1186/s12873-023-00798-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/24/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Urgent and emergency care (UEC) settings provide an opportunity to prevent ill-health and promote healthy lifestyles with potential to screen and deliver interventions to under-served, at-risk populations. The aim of this study was to synthesise and summarise the evidence on the effectiveness and implementation of interventions for health promotion in UEC settings. METHODS PubMed and Embase (OVID) databases were used to search for studies published in English between January 2010 and January 2023. Systematic reviews and meta-analyses of studies that examined the effectiveness or implementation of face-to-face health promotion interventions for lifestyle behaviours delivered in UEC settings were eligible. Extracted data were synthesised and qualitatively summarised by lifestyle behaviour. Reviews were quality assessed using AMSTAR 2. RESULTS Eighteen reviews met the inclusion criteria; all included studies were conducted in emergency departments or trauma units. We identified 15 reviews on alcohol interventions (13 on effectiveness; 2 on implementation) and 3 on smoking interventions (effectiveness). There were no reviews of intervention studies targeting physical activity or diet and nutrition. There was heterogeneity across studies for study design, target populations, intervention design and content, comparator/control groups and outcomes assessed. The effectiveness of alcohol and smoking interventions in UEC settings varied but some reviews provided evidence of a significant decrease in alcohol consumption, alcohol-related outcomes and smoking in intervention groups, particularly in the short-term and in specific population groups. Research has focused on 'brief' interventions as part of screening, brief intervention and referral to treatment (SBIRT) approaches. Interventions are delivered by a wide range of staff with substantial variation in design. Alcohol brief interventions appear to be acceptable to UEC patients but clinicians face barriers in delivering them. CONCLUSIONS UEC settings have been under-researched and appear to be under-utilised for delivering health promotion activities, except for alcohol prevention. Review level evidence suggests alcohol and smoking interventions are warranted in some population groups. However, further research is needed to determine the optimal intervention design, content and delivery mode for lifestyle behaviours which are suitable for implementation in UEC settings and promote long-term intervention effectiveness. Changes in clinical practice may be needed, including increased training, integration into service delivery and supportive policy, to facilitate the implementation of SBIRT for lifestyle behaviours. Interventions may need to be delivered in the wider UEC system such as urgent care centres, minor injury units and walk-in centres, in addition to emergency departments and trauma units, to support and increase health promotion activities in UEC settings.
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Affiliation(s)
- Emma J Adams
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - Lucy Morris
- DREEAM: Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Goolnora Marshall
- DREEAM: Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Frank Coffey
- School of Health Sciences, University of Nottingham, Nottingham, UK
- DREEAM: Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Philip D Miller
- East Midlands Academic Health Science Network, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Llamosas-Falcón L, Rehm J. Alcohol consumption in Spain. Med Clin (Barc) 2023; 160:302-304. [PMID: 36774288 DOI: 10.1016/j.medcli.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Laura Llamosas-Falcón
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canadá.
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canadá; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canadá; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canadá; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canadá; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canadá; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Alemania; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburgo, Alemania; Program on Substance Abuse, Public Health Agency of Catalonia, Program on Substance Abuse & designated WHO CC, Public Health Agency of Catalonia, Barcelona, España
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Awan H, Vergis N. Psychosocial and Pharmacological Therapies to Reduce Alcohol Consumption in Severe Alcohol-Related Hepatitis Patients: A Case Report. Cureus 2023; 15:e37443. [PMID: 37182058 PMCID: PMC10174594 DOI: 10.7759/cureus.37443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Alcohol-related hepatitis (ARH) is an inflammatory liver disease caused by excessive alcohol intake over time. This represents a major health burden with a high mortality and poor prognosis. Reducing alcohol consumption is key to improving health outcomes and long-term mortality. Therefore, various measures have been implemented to aid in the reduction of alcohol consumption. On a population level, this includes minimum unit pricing to reduce alcohol purchases. On a patient level, evidence-based psychosocial and pharmacological therapies aid in achieving and maintaining alcohol abstinence, which will be explored through this case report. A 39-year-old male with a four-year history of alcohol excess was admitted to a regional hospital. He presented with acute onset jaundice and examination findings were consistent with signs of chronic liver disease including abdominal distension and confusion. Investigations supported a diagnosis of severe ARH in this alcohol-dependent patient. Upon discharge, the patient received regular online cognitive behavioral therapy (CBT) sessions to aid in his abstinence. Psychosocial therapy for alcohol abstinence can be categorized into brief and extended interventions. Brief interventions are short counseling sessions, which may be most effective in non-alcohol-dependent patients, whereas extended therapies including CBT, motivational enhancement therapy, and 12-step facilitation are longer regular therapies that may be more effective for alcohol-dependent patients. Some pharmacotherapies are contraindicated in ARH patients due to their hepatotoxicity and liver metabolism. However, acamprosate and baclofen are appropriate and effective treatments. Combining psychosocial and pharmacological therapy may be more beneficial than individual treatments to achieve and maintain abstinence.
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Affiliation(s)
- Humza Awan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, GBR
| | - Nikhil Vergis
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, GBR
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48
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Bertholet N, Schmutz E, Cunningham JA, McNeely J, Gmel G, Daeppen JB, Grazioli VS. Development of a Secondary Prevention Smartphone App for Students With Unhealthy Alcohol Use: Results From a Qualitative Assessment. JMIR Hum Factors 2023; 10:e41088. [PMID: 36881448 PMCID: PMC10031438 DOI: 10.2196/41088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/28/2022] [Accepted: 01/01/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population. OBJECTIVE This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population. METHODS The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ≥18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing. RESULTS The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: "General Acceptance of the App," "Importance of the Targeted and Relevant App Content," "Importance of Credibility," "Importance of the App Usability," "Importance of a Simple and Attractive Design," "Importance of Notifications to Ensure App Use over Time." Besides a general acceptance of the app, these themes reflected participants' recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved. CONCLUSIONS Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time. TRIAL REGISTRATION ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-020-4145-2.
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Affiliation(s)
- Nicolas Bertholet
- Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Elodie Schmutz
- Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - John A Cunningham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jennifer McNeely
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States
| | - Gerhard Gmel
- Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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Botwright S, Sutawong J, Kingkaew P, Anothaisintawee T, Dabak SV, Suwanpanich C, Promchit N, Kampang R, Isaranuwatchai W. Which interventions for alcohol use should be included in a universal healthcare benefit package? An umbrella review of targeted interventions to address harmful drinking and dependence. BMC Public Health 2023; 23:382. [PMID: 36823618 PMCID: PMC9948368 DOI: 10.1186/s12889-023-15152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND This study aimed to identify targeted interventions for the prevention and treatment of harmful alcohol use. Umbrella review methodology was used to summarise the effectiveness across a broad range of interventions, in order to identify which interventions should be considered for inclusion within universal health coverage schemes in low- and middle-income countries. METHODS AND FINDINGS We included systematic reviews with meta-analysis of randomised controlled trials (RCTs) on targeted interventions addressing alcohol use in harmful drinkers or individuals with alcohol use disorder. We only included outcomes related to alcohol consumption, heavy drinking, binge drinking, abstinence, or alcohol-attributable accident, injury, morbidity or mortality. PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and the International HTA Database were searched from inception to 3 September 2021. Risk of bias of reviews was assessed using the AMSTAR2 tool. After reviewing the abstracts of 9,167 articles, results were summarised narratively and certainty in the body of evidence for each intervention was assessed using GRADE. In total, 86 studies met the inclusion criteria, of which the majority reported outcomes for brief intervention (30 studies) or pharmacological interventions (29 studies). Overall, methodological quality of included studies was low. CONCLUSIONS For harmful drinking, brief interventions, cognitive behavioural therapy, and motivational interviewing showed a small effect, whereas mentoring in adolescents and children may have a significant long-term effect. For alcohol use disorder, social network approaches and acamprosate showed evidence of a significant and durable effect. More evidence is required on the effectiveness of gamma-hydroxybutyric acid (GHB), nalmefene, and quetiapine, as well as optimal combinations of pharmacological and psychosocial interventions. As an umbrella review, we were unable to identify the extent to which variation between studies stemmed from differences in intervention delivery or variation between country contexts. Further research is required on applicability of findings across settings and best practice for implementation. Funded by the Thai Health Promotion Foundation, grant number 61-00-1812.
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Affiliation(s)
- Siobhan Botwright
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand.
| | - Jiratorn Sutawong
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand.
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Thunyarat Anothaisintawee
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Chotika Suwanpanich
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Nattiwat Promchit
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Roongnapa Kampang
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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50
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Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Weisner CM, Satre DD, Grant RW, Elson J, Ross TB, Awsare S, Lu Y, Metz VE, Sterling SA. Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study. BMJ Open 2023; 13:e064088. [PMID: 36657762 PMCID: PMC9853251 DOI: 10.1136/bmjopen-2022-064088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D). DESIGN A population-based observational study using electronic health records data. SETTING An integrated healthcare system that implemented system-wide alcohol screening, BI and referral to treatment in adult primary care. PARTICIPANTS Adult primary care patients with hypertension (N=72 979) or T2D (N=19 642) who screened positive for unhealthy alcohol use between 2014 and 2017. MAIN OUTCOME MEASURES We examined four drinking outcomes: changes in heavy drinking days/past 3 months, drinking days/week, drinks/drinking day and drinks/week from baseline to 12-month follow-up, based on results of alcohol screens conducted in routine care. Health outcome measures were changes in measured systolic and diastolic blood pressure (BP) and BP reduction ≥3 mm Hg at 18-month follow-up. For patients with T2D, we also examined change in glycohaemoglobin (HbA1c) level and 'controlled HbA1c' (HbA1c<8%) at 18-month follow-up. RESULTS For patients with hypertension, those who received BI had a modest but significant additional -0.06 reduction in drinks/drinking day (95% CI -0.11 to -0.01) and additional -0.30 reduction in drinks/week (95% CI -0.59 to -0.01) at 12 months, compared with those who did not. Patients with hypertension who received BI also had higher odds for having clinically meaningful reduction of diastolic BP at 18 months (OR 1.05, 95% CI 1.00 to 1.09). Among patients with T2D, no significant associations were found between BI and drinking or health outcomes examined. CONCLUSIONS Alcohol BI holds promise for reducing drinking and helping to improve health outcomes among patients with hypertension who screened positive for unhealthy drinking. However, similar associations were not observed among patients with T2D. More research is needed to understand the heterogeneity across diverse subpopulations and to study BI's long-term public health impact.
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Affiliation(s)
- Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Constance M Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Joseph Elson
- Permanente Medical Group, San Francisco, California, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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