Alcohol Screening and Brief Intervention in Primary Health Care in Kazakhstan—Results of a Cluster Randomised Pilot Study

Objective: The aim of this pilot trial was to assess the feasibility of ASBI in primary health care units (PHCUs) in Kazakhstan.

Methods: A two-arm cluster randomised trial in five PHCUs based on the RE-AIM framework for implementation studies was carried out. Patients with AUDIT-C scores ≥4 for females and ≥5 for males received a brief face-to-face intervention delivered by a trained physician plus information leaflet (intervention group, IG) or simple feedback including a leaflet (control group, CG).

Results: Among 7327 patients eligible for alcohol screening according to the inclusion criteria 1148 patients were screened (15.7%, IG: 11.5%, CG: 27.3%). 12.3% (N = 141) were tested AUDIT-C positive (IG: 9.9%, CG: 15.1%). Out of 112 physicians invited, 48 took part in the ASBI training, 31 finally participated in the study, 21 in the IG (2 PHCUs), 10 in the CG (3 PHCUs). The majority of physicians did not have difficulties in performing the intervention.

Conclusion: ASBI is feasible and can be implemented into PHC settings in Kazakhstan. However, the implementation depends on the willingness and interest of the PHCU and the physicians.

Parameters for Change in Offline Gambling Behavior After the First COVID-19 Lockdown in Germany

Introduction

In spring 2020, the first nationwide lockdown in response to the spreading COVID-19 pandemic came into effect in Germany. From March to May, gambling venues, casinos, and betting offices were forced to close. This study explores how land-based gamblers respond to short-term closures of higher-risk forms of gambling. Which gamblers are particularly susceptible to switching to online gambling? Which are more likely to use the lockdown as an opportunity to quit or pause gambling? Potential parameters for these switching or cessation processes are identified using multivariate multinomial logistic regression analysis.

Methods

The research questions are analyzed on the basis of quantitative data. For this purpose, a survey was conducted among members of a comparatively large German online access panel (“PAYBACK panel”). The sample of analysis consisted of 612 gamblers who had participated in at least one higher-risk form of gambling and had done so exclusively offline before the first lockdown (January and February 2020).

Results

A total of 37.1% of sports bettors ceased participation in higher-risk forms of gambling, compared to 64.1% of casino gamblers. Switching to online gambling, on the other hand, was a rather rare event, regardless of the form of gambling: the proportions differ between 7.7% (slot machines) and 10.9% (sports betting). In the multivariate model female gender, younger age, and a lower frequency of gambling before the first lockdown were found to be significant factors for quitting (instead of continuing) higher-risk offline gambling forms. Secondly, the analysis revealed that individuals with more pronounced cognitive distortions had an increased risk of switching to online gambling rather than staying offline.

Discussion

A key finding of this study is that the temporary closure of offline venues does not result in a significant shift towards the online market. Instead, the results of this study show that these short, temporary closures of gambling venues were an appropriate opportunity to give individual groups of gamblers the opportunity to reflect, reduce or quit gambling. It is worth considering implementing such temporary closures as a preventive measure in the future – this should be investigated in advance in further evaluation studies.

Feasibility of alcohol screening and brief intervention in primary health care in Kazakhstan: study protocol of a pilot cluster randomised trial

BACKGROUND

Identifying and addressing heavy drinking represents a major public health priority worldwide. Whilst the majority of alcohol screening and brief intervention (ASBI) research has been conducted in western, high-income countries, evidence is growing that ASBI can also impact positively on heavy drinkers in low- and middle-income country populations. This mixed methods study aims to assess the feasibility of conducting a fully randomised controlled trial of the effectiveness of ASBI in primary care in Kazakhstan and explore the feasibility and acceptability of implementing ASBI in this setting from patients' and physicians' perspectives.

METHODS

Six primary health care units in the region of Pavlodar will be cluster randomised to either an intervention (WHO manualised 5 min alcohol brief intervention plus alcohol leaflet) or control group (simple feedback plus alcohol leaflet). Primary feasibility measures will be rates of participation at baseline and retention of eligible patients at the 3-month follow-up point. Patient/physician questionnaires and physician focus groups will assess additional dimensions of feasibility, as well as acceptability, according to the RE-AIM framework: Reach (rates of eligible patients screened/received advice); Effectiveness (change in AUDIT-C score); Adoption (rate/representativeness of participating physicians); Implementation (quality of ASBI/barriers and facilitators to delivery); and Maintenance (potential sustainability of intervention).

DISCUSSION

This is the first trial of the feasibility and acceptability of ASBI in Kazakhstan. As the planning and assessment of implementation determinants is based on the RE-AIM framework, the project outcomes will be relevant for the future development, tailoring and implementation of ASBI in Kazakhstan.

TRIAL REGISTRATION

DRKS, DRKS00015882, Registered 17 December 2018.

Comparative Analysis of Potential Risk Factors for at-Risk Gambling, Problem Gambling and Gambling Disorder among Current Gamblers-Results of the Austrian Representative Survey 2015

Background: The risk of developing a problem gambling behavior is distributed unequally among the population. For example, individuals who report stressful life events, show impairments of mental health or belong to a socio-economically deprived group are affected more frequently by gambling problems. The aim of our study is to investigate whether these risk factors are equally relevant for all gambling groups (social = 0 DSM-5 criteria, at risk = 1 DSM-5 criterion, problem = 2–3 DSM-5 criteria, disordered = 4–9 DSM-5 criteria).

Methods: Of a total of 10,000 participants in the representative gambling survey in Austria in 2015, 4,082 individuals reported gambling during the last 12 months and were allocated to the four gambling groups according to DSM-5. With social gamblers as the reference group, relevant risk factors for the other three groups were identified by means of bi- and multivariate multinomial logistic regression.

Results: Significant risk factors for gambling disorder are at-risk alcohol use (OR = 4.9), poor mental health (OR = 5.9), young age (≤26 years, OR = 2.1), a low level of formal education (OR = 2.4), having grown up with a single parent (OR = 2.5), parents with addiction problems (OR = 2.3) and belonging to the working class (OR = 2.9). Risk factors for problem gambling are parents with addiction problems (OR = 3.8), poor mental health (OR = 2.6) and a young age (OR = 2.2). With regard to at-risk gambling, only growing up with a single parent was relevant (OR = 2.4).

Conclusion: Overall, the results of this study suggest, that the number and the influence of the included risk factors differ between gambling problem groups. Apparently, the development of severe gambling problems is to a lesser extent facilitated by specific risk factors than by their cumulative presence. Therefore, future prevention and treatment measures should place a particular focus on individuals who have experienced growing up in a difficult family situation, have poor mental health, suffer from substance-related problems or have a low level of formal education.