The eCHECKUP TO GO for High School: Impact on risk factors and protective behavioral strategies for alcohol use

A randomized controlled trial testing the efficacy of the eCHECKUP TO GO on drinking games participation and behavior among high school seniors

BACKGROUND

Among high school students, seniors report the highest levels of hazardous drinking behavior, including playing drinking games. Technology-based interventions are a promising approach for reducing hazardous drinking behavior among this age group.

OBJECTIVES

This randomized controlled trial investigated the efficacy of the eCHECKUP TO GO, an online personalized feedback intervention, on reducing the frequency of playing drinking games, the number of drinks consumed while playing drinking games, and the number of drinks consumed on occasions when drinking games were played among high school seniors (ClinicalTrials.gov Identifier NCT03613818).

METHOD

Participants were recruited from two high schools. Class periods were randomized to the intervention condition or an assessment-only control condition. Participants completed online surveys at baseline, 30-day, and 6-month assessments. The subsample in this study (N = 109) consisted of high-risk drinkers (i.e., students reporting binge drinking in the past two weeks at baseline).

RESULTS

We did not find any significant differences in frequency of playing drinking games between the intervention and control conditions. For number of drinks consumed, students in the intervention condition reported a significant reduction in the number of drinks consumed while playing drinking games (p < 0.01) and total number of drinks consumed on drinking game occasions (p < 0.04) at the 30-day follow-up relative to students in the control condition. Reductions within the intervention group were sustained at the 6-month follow-up.

CONCLUSIONS

Results support the efficacy of the eCHECKUP TO GO for decreasing hazardous alcohol use among high school seniors.

A systematic review on eHealth technology personalization approaches

Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.

Social features in internet-based programs to prevent alcohol consumption among adolescents: a scoping review

Alcohol consumption among adolescents is a social and public health issue. School-based programs are needed to prevent the onset of alcohol consumption during adolescence. Information and communication technologies offer new promising approaches to deliver preventive programs to these populations. The most traditional, successful programs use group dynamics within the classroom. However, the usefulness of social interaction features (SIF) within internet-based interventions remains unclear. The current scoping review aims to identify and evaluate the effectiveness of online and mobile psychosocial preventive interventions that use SIF, and that target adolescents. Web of Science, Scopus and Google Scholar were electronically searched for all articles published between January 2011 and December 2020. Articles reporting on school-based, web-based interventions for adolescents to prevent alcohol consumption and that encouraged any kind of interaction between users ('social interactions') were eligible for inclusion. Fourteen articles were included in the review. These articles assessed eight preventive programs. Six programs showed positive results on outcome variables. In two of them, it was possible to determine that their success was partially due to the SIF. SIF seem to be useful to enhance the receptivity and usefulness of web-based prevention programs, but the current evidence of their effectiveness is scarce. More evidence is required to assess the effectiveness of these features and to improve programs having the objective of preventing the consumption of alcohol among young people.

The Effectiveness of Web-Based Interventions to Promote Health Behaviour Change in Adolescents: A Systematic Review

Although web-based interventions are attractive to researchers and users, the evidence about their effectiveness in the promotion of health behaviour change is still limited. Our aim was to review the effectiveness of web-based interventions used in health behavioural change in adolescents regarding physical activity, eating habits, tobacco and alcohol use, sexual behaviour, and quality of sleep. Studies published from 2016 till the search was run (May-to-June 2021) were included if they were experimental or quasi-experimental studies, pre-post-test studies, clinical trials, or randomized controlled trials evaluating the effectiveness of web-based intervention in promoting behaviour change in adolescents regarding those health behaviours. The risk of bias assessment was performed by using the Effective Public Health Practice Project (EPHPP)-Quality Assessment Tool for Quantitative Studies. Fourteen studies were included. Most were in a school setting, non-probabilistic and relatively small samples. All had a short length of follow-up and were theory driven. Thirteen showed significant positive findings to support web-based interventions' effectiveness in promoting health behaviour change among adolescents but were classified as low evidence quality. Although this review shows that web-based interventions may contribute to health behaviour change among adolescents, these findings rely on low-quality evidence, so it is urgent to test these interventions in larger controlled trials with long-term maintenance.

Effects of a cannabis use disorder text message-delivered treatment on young adult alcohol misuse: Differential effects by gender

Alcohol misuse is more prevalent, frequent, and severe among young adults who use cannabis. Treatment of dual alcohol and cannabis users may have mixed results, with some studies reporting that alcohol misuse increases when cannabis use decreases (substance substitution), while others report that alcohol misuse decreases along with decreasing cannabis use (treatment spillover), and others report no association. Additionally, little research tests whether gender differences are found in treatment of dual alcohol and cannabis users, which may be expected given previous alcohol-focused treatments showing larger effects for females. In the current study, we present a secondary analysis of a randomized clinical trial testing a text message-delivered cannabis use disorder (CUD) treatment (peer network counseling text or "PNC-txt"). The trial included 101 young adults ages 18-25 who met criteria for CUD. We tested whether alcohol use and binge drinking frequency (4+/5+ drinks for women/men) decreased in response to the PNC-txt treatment, which has previously shown effectiveness in reducing cannabis use days. Latent growth models tested PNC-txt effects on the monthly rate of change in alcohol use and binge drinking across three months. In the full sample, we found no evidence of significant treatment effects on alcohol use (d = -0.07) or binge drinking (d = -0.10). Moderation analyses, however, indicated the PNC-txt effect on both alcohol use and binge drinking differed significantly by gender. PNC-txt led to significantly larger decreases in alcohol use (d = -0.53) and binge drinking days (d = -0.43) across the three months for females, whereas the study saw opposite (but nonsignificant) effects for males (d = 0.30 and 0.16 for alcohol use and binge drinking, respectively). We found no evidence that reductions in alcohol use and binge drinking were associated with cannabis use decreases, arguing against direct substitution or spillover effects. These results provide evidence that treatments focused on cannabis use may have secondary beneficial effects for young-adult alcohol misuse, although such effects may be limited to women.

A systematic review of alcohol education programs for young people: do these programs change behavior?

Numerous education programs have addressed young peoples' alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15-24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes.

Reducing Alcohol Use among High School Athletes: A Randomized Controlled Trial of a Brief, Web-Based Personalized Normative Feedback Intervention

High school athletes are at risk for heavy alcohol use, which is associated with consequences that may negatively impact performance and eligibility to participate in sports. This study evaluated the efficacy of a web-based personalized normative feedback (PNF) intervention on reducing alcohol use among high school athletes in their senior year. Class periods were randomized to the intervention or an assessment-only control group. Athletes completed surveys at baseline and a 6-week follow-up. Athletes were classified as high-risk or low-risk drinkers based on baseline reports of binge drinking. Results indicated for athletes classified as high-risk drinkers, those in the intervention group reported significantly greater reductions in quantity of weekly drinking and peak drinking quantity compared to those in the assessment-only control group. There were no significant intervention effects for frequency of alcohol use. Findings provide support the efficacy of web-based PNF intervention for reducing alcohol use among high school senior athletes.

A Randomized Controlled Trial of the eCHECKUP to GO for High School Seniors across the Academic Year

Among high school students, seniors report the highest levels of alcohol use and hazardous drinking. Technology-based interventions are a promising approach for reducing alcohol use among this age group. Objectives: This randomized controlled trial investigated the efficacy of the eCHECKUP TO GO, an online personalized feedback intervention, on reducing alcohol use among high school seniors across the academic year (ClinicalTrials.gov Identifier NCT03613818). Drinker risk status, with students classified as high- or low-risk drinkers based on baseline reports binge drinking, was examined as a moderator of intervention effects. Method: Participants (N = 311) were recruited from two high schools. Class periods were randomized to the intervention condition or an assessment-only control condition. Participants completed online surveys at baseline, 30-day, and 6-month assessments. Results: Intervention effects were moderated by drinker risk status. Among high-risk drinkers, those in the intervention condition reported a significant reduction in weekly drinking quantity and estimated blood alcohol concentration (eBAC) at the 30-day follow-up relative to students in the control condition. By 6 months, reductions in alcohol outcomes among high-risk students in the intervention condition were sustained, but high-risk students in the control condition also reported reductions in weekly drinking. In contrast, for eBAC, intervention effects were significantly greater among students in the intervention condition relative to the control condition at 6 months. Conclusions: Results support the efficacy of the eCHECKUP TO GO for decreasing short-term alcohol use among seniors who are high-risk drinkers and provide preliminary evidence that reductions are sustained across the academic year.

Efficacy of the eCHECKUP TO GO for High School Seniors: Sex Differences in Risk Factors, Protective Behavioral Strategies, and Alcohol Use

OBJECTIVE

The purpose of this randomized controlled study was to examine sex as a moderator of the efficacy of a brief, web-based personalized feedback intervention (eCHECKUP TO GO) on decreasing cognitive risk factors for alcohol use, increasing protective behavioral strategies, and reducing alcohol use among high school seniors.

METHOD

Participants (n = 311) were high school seniors randomized by class period to the eCHECKUP TO GO intervention or assessment-only control group. Participants completed online surveys at baseline and 30-day follow-up (91.0%; n = 283).

RESULTS

Students in the intervention group reported a significant reduction in normative perceptions of peer drinking, positive alcohol expectancies, and alcohol use relative to those in the control group. Intervention effects for perceptions of frequency of peer drunkenness and frequency of alcohol use were moderated by sex, with results favoring females. In contrast, we did not find evidence for sex as a moderator of intervention effects for normative perceptions of peer drinking frequency, sex-specific perceptions of peer heavy episodic drinking, positive alcohol expectancies, or peak drinking quantity. Further, we did not find significant intervention or moderator effects for protective behavioral strategies.

CONCLUSIONS

Results of this study extend the literature by demonstrating the efficacy of the eCHECKUP TO GO for both males and females on reducing cognitive risk factors and alcohol use, although results were significant for a broader range of variables for females. Results also indicate that program content regarding normative feedback and protective behavioral strategies may need modification to be more effective for this age group.

Sex differences in the acceptability and short-term outcomes of a web-based personalized feedback alcohol intervention for high school seniors

Despite the escalation of alcohol use through high school, the majority of research on school-based alcohol interventions has been conducted with junior high students or first and second year high school students. Preliminary research indicates a brief, web-based personalized feedback intervention developed for college students (eCHECKUP TO GO) may be a promising program for high school seniors. Although these studies demonstrate positive intervention effects, there is some evidence for greater program efficacy for females in this age group. The current study investigates sex differences in program acceptability of the eCHECKUP TO GO and its relationship to short-term alcohol outcomes among high school seniors (N = 135). Overall, the majority of students reported they found the program to be acceptable (i.e., user-friendly and useful). However, contrary to our hypothesis, results indicated that male students reported significantly higher perceptions of program acceptability than females. Although, we did not find sex differences in alcohol outcomes, program user-friendliness was related to reductions in alcohol use for males. Results of this study add to the literature supporting the eCHECKUP TO GO for high school seniors and highlight the importance of program user-friendliness for males. Implications for implementing the program as a school-based intervention are discussed.

A Randomized Controlled Trial Testing the Efficacy of a Brief Online Alcohol Intervention for High School Seniors

OBJECTIVE

The purpose of this randomized controlled study was to examine the efficacy of a brief, web-based personalized feedback intervention (the eCHECKUP TO GO) on alcohol use and alcohol-related consequences among high school seniors.

METHOD

Participants (n = 221) were high school seniors randomized by class period to either a brief, web-based personalized feedback intervention (the eCHECKUP TO GO) or an assessment-only control group. Participants completed online surveys at baseline and at a 6-week follow-up.

RESULTS

Students participating in the eCHECKUP TO GO intervention reported a significant reduction in weekly drinking quantity, peak drinking quantity, and frequency of drinking to intoxication relative to those in the control group. Intervention effects were moderated by high-risk status (one or more episodes of heavy episodic drinking in the past 2 weeks reported at baseline) such that intervention effects were significant for high-risk students only. Results for alcohol-related consequences were not significant.

CONCLUSIONS

Providing a brief, web-based personalized feedback intervention in the school setting is a promising approach for reducing problem alcohol use among high school seniors who report recent heavy episodic drinking.

Computer-Based Prevention and Intervention to Reduce Substance Use in Youth

Purpose of Review

Computer-based programs for substance use prevention and intervention among youth are on the ascendancy. Whether delivered by computer per se or by electronic tablet or smartphone, technology-driven programs are harmonious with how young people access information and interact with their worlds. This review examines recent evidence on computer-based programs aimed at substance use among youth, with particular attention to results from randomized trials.

Recent Findings

Outcome studies of computer-based, substance use-related programs published over the past 5 years reveal mixed results amidst diverse intervention approaches and delivery settings. Many studies are marred by high attrition. Notable in the recent literature is the international nature of technology-driven substance use prevention and intervention programs. With some exceptions, most programs appear to not have been customized for their recipient populations. Though few in number, the highest-quality studies of computer-based programs show positive outcomes in reduced substance use rates.

Summary

Based on recent findings, considerable work needs to happen before computer-delivered approaches are a proven means for reducing substance use among youth. Original programs, expressly developed for subgroups of youth, are in short supply. Though controlled designs are becoming commonplace, too many studies of computer-based programs suffer from flaws-including high rates of attrition-that limit the discovery of positive outcomes.