Mobile phone brief intervention applications for risky alcohol use among university students: a randomized controlled study

Addiction Science & Clinical Practice

Claes Andersson¹  Ingvar Rosendahl³  Kristina Sinadinovic²  Anne H Berman²  Mikael Gajecki³ 

[1]Department of Criminology, Malmö University, Malmö, Sweden

[2]Stockholm Center for Dependency Disorders, Stockholm, Sweden

[3]Karolinska Institutet, Department of Clinical Neuroscience, Center for Psychiatric Research, Stockholm, Sweden

关键词: Brief intervention;    mHealth;    eHealth;    Mobile phone;    Smartphone;    University;    College;    Alcohol abuse;    Problem drinking;    Randomized controlled trial;   

Others  :  1082113
DOI  :  10.1186/1940-0640-9-11

 received in 2013-12-19, accepted in 2014-06-26,  发布年份 2014

【 摘 要 】

Background

Brief interventions via the internet have been shown to reduce university students’ alcohol intake. This study tested two smartphone applications (apps) targeting drinking choices on party occasions, with the goal of reducing problematic alcohol intake among Swedish university students.

Methods

Students were recruited via e-mails sent to student union members at two universities. Those who gave informed consent, had a smartphone, and showed risky alcohol consumption according to the Alcohol Use Disorders Identification Test (AUDIT) were randomized into three groups. Group 1 had access to the Swedish government alcohol monopoly’s app, Promillekoll, offering real-time estimated blood alcohol concentration (eBAC) calculation; Group 2 had access to a web-based app, PartyPlanner, developed by the research group, offering real-time eBAC calculation with planning and follow-up functions; and Group 3 participants were controls. Follow-up was conducted at 7 weeks.

Results

Among 28574 students offered participation, 4823 agreed to join; 415 were excluded due to incomplete data, and 1932 fulfilled eligibility criteria for randomization. Attrition was 22.7–39.3 percent, higher among heavier drinkers and highest in Group 2. Self-reported app use was higher in Group 1 (74%) compared to Group 2 (41%). Per-protocol analyses revealed only one significant time-by-group interaction, where Group 1 participants increased the frequency of their drinking occasions compared to controls (p = 0.001). Secondary analyses by gender showed a significant difference among men in Group 1 for frequency of drinking occasions per week (p = 0.001), but not among women. Among all participants, 29 percent showed high-risk drinking, over the recommended weekly drinking levels of 9 (women) and 14 (men) standard glasses.

Conclusions

Smartphone apps can make brief interventions available to large numbers of university students. The apps studied using eBAC calculation did not, however, seem to affect alcohol consumption among university students and one app may have led to a negative effect among men. Future research should: 1) explore ways to increase user retention, 2) include apps facilitating technical manipulation for evaluation of added components, 3) explore the effects of adapting app content to possible gender differences, and 4) offer additional interventions to high-risk users.

Trial registration

clinicaltrials.gov: NCT01958398.

【 授权许可】

   
2014 Gajecki et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 14.

【 参考文献 】

• [1]Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE: Monitoring the Future National Results on Drug Use: 2012 Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, The University of Michigan; 2013.
• [2]Andersson C, Johnsson KO, Berglund M, Ojehagen A: Alcohol involvement in Swedish university freshmen related to gender, age, serious relationship and family history of alcohol problems. Alcohol Alcohol 2007, 42:448-455.
• [3]Larimer ME, Cronce JM: Identification, prevention and treatment: a review of individual-focused strategies to reduce problematic alcohol consumption by college students. J Stud Alcohol Suppl 2002, 14:148-163.
• [4]Larimer ME, Cronce JM: Identification, prevention, and treatment revisited: individual-focused college drinking prevention strategies 1999–2006. Addict Behav 2007, 32:2439-2468.
• [5]Seigers DK, Carey KB: Screening and brief interventions for alcohol use in college health centers: a review. J Am Coll Health 2010, 59:151-158.
• [6]Ajzen I: The theory of planned behavior. Organ Behav Hum Decis Process 1991, 50:179-211.
• [7]Glassman T, Braun RE, Dodd V, Miller JM, Miller EM: Using the theory of planned behavior to explain the drinking motivations of social, high-risk, and extreme drinkers on game day. J Community Health 2010, 35:172-181.
• [8]Collins SE, Carey KB: The theory of planned behavior as a model of heavy episodic drinking among college students. Psychol Addict Behav 2007, 21:498-507.
• [9]Conner M, Warren R, Close S, Sparks P: Alcohol consumption and the theory of planned behavior: an examination of the cognitive mediation of past behavior. J Appl Soc Psychol 1999, 29:1676-1704.
• [10]Martens MP, Ferrier AG, Cimini MD: Do protective behavioral strategies mediate the relationship between drinking motives and alcohol use in college students? J Stud Alcohol Drugs 2007, 68:106-114.
• [11]Ray AE, Turrisi R, Abar B, Peters KE: Social-cognitive correlates of protective drinking behaviors and alcohol-related consequences in college students. Addict Behav 2009, 34:911-917.
• [12]Martens MP, Martin JL, Littlefield AK, Murphy JG, Cimini MD: Changes in protective behavioral strategies and alcohol use among college students. Drug Alcohol Depend 2011, 118:504-507.
• [13]Araas TE, Adams TB: Protective behavioral strategies and negative alcohol-related consequences in college students. J Drug Educ 2008, 38:211-224.
• [14]Andersson C, Johnsson KO, Berglund M, Ojehagen A: Intervention for hazardous alcohol use and high level of stress in university freshmen: a comparison between an intervention and a control university. Brain Res 2009, 1305:S61-S71.
• [15]Barnett NP, Murphy JG, Colb SM, Monti PM: Efficacy of counselor vs. computer-delivered intervention with mandated college students. Addict Behav 2007, 32:2529-2548.
• [16]Nilsen P: Brief alcohol intervention—where to from here? Challenges remain for research and practice. Addiction 2010, 105:954-959.
• [17]White A, Kavanagh D, Stallman H, Klein B, Kay-Lambkin F, Proudfoot J, Drennan J, Connor J, Baker A, Hines E, Young R: Online alcohol interventions: a systematic review. J Med Internet Res 2010, 12:e62.
• [18]Khadjesari Z, Murray E, Hewitt C, Hartley S, Godfrey C: Can stand-alone computer-based interventions reduce alcohol consumption? A systematic review. Addiction 2011, 106:267-282.
• [19]Elliott JC, Carey KB, Bolles JR: Computer-based interventions for college drinking: a qualitative review. Addict Behav 2008, 33:994-1005.
• [20]Carey KB, Scott-Sheldon LA, Elliott JC, Bolles JR, Carey MP: Computer-delivered interventions to reduce college student drinking: a meta-analysis. Addiction 2009, 104:1807-1819.
• [21]Moreira MT, Smith LA, Foxcroft D: Social norms interventions to reduce alcohol misuse in university or college students. Cochrane Database Syst Rev 2009, CD006748. doi:10.1002/14651858.CD006748.pub2
• [22]Findahl O: Swedes and the Internet. Stockholm: the Internet Infrastructure Foundation; 2013.
• [23]Weaver ER, Horyniak DR, Jenkinson R, Dietze P, Lim MSC: Let's get wasted! and other apps: characteristics, acceptability, and use of alcohol-related smartphone applications. JMIR Mhealth Uhealth 2013, 1(1):E9. http://mhealth.jmir.org/2013/1/e9/ webcite
• [24]Cohn AM, Hunter-Reel D, Hagman BT, Mitchell J: Promoting behavior change from alcohol use through mobile technology: the future of ecological momentary assessment. Alcohol Clin Exp Res 2011, 35:2209-2215.
• [25]Fromme K, Marlatt GA, Baer JS, Kivlahan DR: The alcohol skills training program — a group intervention for young-adult drinkers. J Subst Abuse Treat 1994, 11:143-154.
• [26]Dimeff LA, Baer JS, Kivlahan DR, Marlatt GA: Brief Alcohol Screening and Intervention for College Students (BASICS): A Harm Reduction Approach. New York: Guilford Press; 1999.
• [27]Baer JS, Marlatt GA, Kivlahan DR, Fromme K, Larimer ME, Williams E: An experimental test of three methods of alcohol risk reduction with young adults. J Consult Clin Psychol 1992, 60:974-979.
• [28]Riper H, van Straten A, Keuken M, Smit F, Schippers G, Cuijpers P: Curbing problem drinking with personalized-feedback interventions: a meta-analysis. Am J Prev Med 2009, 36:247-255.
• [29]Andersson C: Comparison of automated technologies to deliver brief alcohol interventions to university students. Alcohol Clin Exp Res 2012, 36:86A. http://onlinelibrary.wiley.com/doi/10.1111/acer.2012.36.issue-s2/issuetoc webcite
• [30]Wilk AI, Jensen NM, Havighurst TC: Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med 1997, 12:274-283.
• [31]Bien TH, Miller WR, Tonigan JS: Brief interventions for alcohol problems — a review. Addiction 1993, 88:315-335.
• [32]Ballesteros J, Gonzalez-Pinto A, Querejeta I, Arino J: Brief interventions for hazardous drinkers delivered in primary care are equally effective in men and women. Addiction 2004, 99:103-108.
• [33]Collins RL, Parks GA, Marlatt GA: Social determinants of alcohol consumption: the effects of social interaction and model status on the self-administration of alcohol. J Consult Clin Psychol 1985, 53:189-200.
• [34]Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M: Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol-consumption–II. Addiction 1993, 88:791-804.
• [35]Bergman H, Kallmen H: Alcohol use among Swedes and a psychometric evaluation of the alcohol use disorders identification test. Alcohol Alcohol 2002, 37:245-251.
• [36]National Highway Traffic Safety Administration: Computing a BAC estimate. Washington, DC: U.S: Department of Transportation; 1994. http://www.craftbeer.com/attachments/0000/1170/Computing_a_BAC_Estimate.pdf webcite
• [37]Bergman H, Källmén H: Svenska kvinnor har fått mer riskfyllda och skadligare alkoholvanor. Undersökning av förändringar i svenskarnas alkoholvanor åren 1997–2001. [Swedish women show more hazardous and harmful alcohol habits. Investigation of changes in Swedes’ alcohol habits during the period 1997–2001]. Lakartidningen 2003, 100:1028-1035.
• [38]Sinadinovic K, Wennberg P, Berman AH: Population screening of risky alcohol and drug use via internet and interactive voice response (IVR): a feasibility and psychometric study in a random sample. Drug Alcohol Depend 2011, 114:55-60.
• [39]Sinadinovic K, Berman AH, Hasson D, Wennberg P: Internet-based assessment and self-monitoring of problematic alcohol and drug use. Addict Behav 2010, 35:464-470.
• [40]Swedish National Institute of Public Health: Riskbruk [Hazardous use]. http://www.torget.fhi.se/Vart-uppdrag/Alkohol-narkotika-dopning-tobak-och-spel/Alkohol1/Riskbruk/ webcite
• [41]Fillmore MT, Jude R: Defining ”binge” drinking as five drinks per occasion or drinking to a.08% BAC: which is more sensitive to risk? Am J Addict 2011, 20:468-475.
• [42]Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG: AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. 2nd edition. Geneva: World Health Organization; 2001.
• [43]Schomerus G, Lucht M, Holzinger A, Matschinger H, Carta MG, Angermeyer MC: The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol 2011, 46:105-112.
• [44]Doumas DM, Hannah E: Preventing high-risk drinking in youth in the workplace: a web-based normative feedback program. J Subst Abuse Treat 2008, 34:263-271.
• [45]Tensil MD, Jonas B, Struber E: Two fully automated web-based interventions for risky alcohol use: randomized controlled trial. J Med Internet Res 2013, 15:e110. doi: 10.2196/jmir.2489
• [46]Wallace P, Murray E, McCambridge J, Khadjesari Z, White IR, Thompson SG, Kalaitzaki E, Godfrey C, Linke S: On-line randomized controlled trial of an internet based psychologically enhanced intervention for people with hazardous alcohol consumption. PLoS One 2011, 6:e14740.