Web-based alcohol screening has limited effect among students

World Health Matters by Gary Finnegan – New Zealand – A web-based alcohol screening and intervention programme had only a minor impact on drinking habits among university students in New Zealand, new research shows.

The programme produced a modest reduction in the amount of alcohol consumed per drinking episode but not in the frequency of drinking, overall amount consumed, or in related academic problems.

Using an internet site to screen students for unhealthy alcohol use and intervene if appropriate had previously been suggested as an inexpensive means of reaching large numbers of young people, according to the researchers. But, while the strategy is relatively low cost, its cost-effectiveness is called into question by the study.

Dr Kypros Kypri of the University of Newcastle, Callaghan, New South Wales, Australia, and colleagues emailed invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening test to 14,991 students (ages 17 to 24 years) at seven New Zealand universities.

Participants who screened positive (AUDIT-C score ≥ 4) were randomised to 10 minutes of online assessment and feedback (including comparisons with medical guidelines and peer norms) on alcohol expenditure, peak blood alcohol concentration, alcohol dependence, and access to help and information, or no further intervention.

A fully automated five-month follow-up assessment was conducted that included a questionnaire regarding alcohol consumption.

Of 5,135 screened students, 3,422 scored four or greater and were randomised, and 83 percent were followed up at five months. Relative to control participants, those who received the intervention consumed less alcohol per typical drinking episode (median four drinks versus five drinks), a finding that was no longer statistically significant after accounting for student attrition from the study.

The intervention was otherwise not effective; participants who received the intervention did not consume alcohol less often or in lower volume; academic problem scores did not differ between groups, and the intervention did not have an effect on the risk of binge drinking.

“The findings underline the importance of pragmatic trials to inform preventive medicine. They indicate that web-based alcohol screening and brief intervention should not be relied upon alone to address unhealthy alcohol use in this population,” the authors said, noting other potential interventions such as restriction in the physical availability and promotion of alcohol.

In an editorial commenting on the study, Dr Timothy S. Naimi of Boston Medical Center, Boston, and Thomas B. Cole, of JAMA, Chicago, said there is little direct evidence that electronic alcohol screening and brief counselling intervention has a meaningful population-level effect on excessive alcohol consumption or related harms in any group.

“And therefore its utility as a stand-alone public health approach is in doubt,” they said.