March 26, 2014

Are web-based student drinking interventions worthwhile?

Heavy drinking and the societal harm it causes is a big issue and attracts a lot of media and scholarly attention (and Statschat’s, too). So we were interested to see today’s new release from the Journal of the American Medical Association. It describes a double-blind, parallel-group, individually-randomised trial that studied moderate to heavy student drinkers from seven of our eight universities to see if a web-based alcohol screening and intervention programme reduced their unhealthy drinking behaviour.

And the short answer? Not really. But if they identified as Māori, the answer was … yes, with a caveat. More on that in a moment.

Statistician Nicholas Horton and colleagues used an online questionnaire to identify students at Otago, Auckland, Canterbury, Victoria, Lincoln, Massey, and Waikato who had unhealthy drinking habits. Half the students were assigned at random to receive personalised feedback and the other students had no input. Five months later, researchers followed up with the students on certain aspects of their drinking.

The overall result? “The intervention group tended to have less drinking and fewer problems then the control group, but the effects were relatively modest,” says Professor Horton. The take-away message: A web-based alcohol screening and intervention program had little effect on unhealthy drinking among New Zealand uni students. Restrictions on alcohol availability and promotion are still needed if we really want to tackle alcohol abuse.

But among Māori students, who comprise 10% of our national uni population, those receiving intervention were found to drink 22% less alcohol and to experience 19% fewer alcohol-related academic problems at the five-month follow-up. The paper suggests that Māori students are possibly more heavily influenced by social-norm feedback than non-Māori students. “Māori students may have a stronger group identity, enhanced by being a small minority in the university setting.” But the paper warns that the difference could also be due to chance, “underscoring the need to undertake replication and further studies evaluating web-based alcohol screening and brief intervention in full-scale effectiveness trials.”

The paper is here. Read the JAMA editorial here.

 

 

 

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Julie Middleton is an Auckland journalist with a keen interest in the way the media uses/abuses data. She happens to be married to a statistician. See all posts by Julie Middleton »

Comments

  • avatar
    megan pledger

    How was it double-blinded?

    I can’t see an ethics committee letting people be treated in a trial without them knowing what the treatment was and without them having the right to opt out. And once knowing what the potential treatment is, a person knows if they get it.

    Also, I suspect it’s not that Maori are more influenced by social-norm feedback but that their norms for alcohol haven’t been set so strongly and so are more easily moved. IIRC, Maori are less likely to use alcohol and their average age at starting is older (compared to Europeans).

    5 months ago Reply

    • avatar
      Kyp Kypri

      Dear Megan
      the issue of blinding is on p.1220 of the paper:

      http://jama.jamanetwork.com/article.aspx?articleid=1849990

      Randomization and Blinding

      Students were sent an e-mail containing a hyperlink to a web questionnaire and were informed that “the main focus of this study is student alcohol use over time and its consequences.” Response to the survey was taken as consent to participate. Respondents who scored 4 or greater were randomly assigned by the web server to the control (screening only) or intervention group. This procedure was used to ensure that participants were blind to the true nature of the study, which was presented as 2 surveys to minimize the potential for research participataion effects.21 Researchers were blind to allocation as randomization and all other study procedures were fully automated and thus could not be subverted. Blinding was considered ethically acceptable,22 given the low risk to participants and benefits in terms of reducing bias.21 Ethical approval for the study was granted by New Zealand’s Multi-region Ethics Committee (MEC/10/01/009).

      If you’re interested in the ethical issues relating to blinding in this particular context, see:

      McCambridge J, Kypri K, Bendtsen P, Porter J (2013). The use of deception in public health behavioural intervention research: a pragmatic examination of the ethical issues. American Journal of Bioethics 13(11):39-4 [with seven commentaries and authors’ response]

      5 months ago Reply

  • avatar
    Julie Middleton

    On the subject of differences between Māori and non-Māori, I have just heard from Kypros Kypri, lead author and a Professor at the School of Medicine & Public Health at the University of Newcastle, Australia. He says: “The differences are really a puzzle, because my sense of having been a uni student in New Zealand, and of teaching and researching student drinking, is that the differences between Māori and non-Māori are not that great. My best guess, based on the discussions with Māori researchers and practitioners, is that the difference in intervention effect is related to concepts of the group and how important it is to a person’s sense of self and belonging.

    “Irrespective of the reasons, it is pleasing to see an intervention that is more effective for Māori rather than less, which is too often the case.”

    The link to the Māori paper is http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.04067.x/abstract

    5 months ago Reply

    • avatar
      megan pledger

      The reasons are kind of important and, as scientists, you’d think we’d be pretty interested in them. It’s the whole enquirey process thing.

      One reason where it might be important is that we might be interested in whether a short intervention treatment might work for heavy marijuana use in Maori.

      Maori use mj more than Euro-NZers and start younger (the opposite of alcohol use).

      If all the effect in a short intervention is to shift users who aren’t set in their ways than a short intervention is going to work better for Euro-NZers than Maori.

      However, if it’s easier to guilt trip Maori into stopping use for the good of their whanau in a short intervention then it will work “better” for Maori than Euro-NZers.

      5 months ago Reply

  • avatar
    Kyp Kypri

    You seem to imply that we are not interested in the reasons for the difference. We are of course interested, however, we have no data in this study that could address our various hypotheses (our best bet is presented in the paper), nor yours.

    I take exception to the phrase “guilt trip” in this context and urge you to read the papers to gain a fuller understanding of the intervention being evaluated and how the research was undertaken.

    5 months ago Reply

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