Alcohol-related harms in adolescents and a pragmatic randomized controlled trial of chat-based intervention with alcohol screening and brief intervention for adolescents with alcohol use disorder

Abstract

Background: This thesis adopted the population-based approach, which aimed to use video-based health talk to prevent secondary school students from becoming regular drinkers and examine the effect of using chat-based intervention combined with alcohol screening and brief intervention (ASBI) for reducing alcohol use in current university student drinkers.

Methods: This work consists of three phases. In phase one, a pre-post study was conducted on 1244 secondary school students to examine their change in the knowledge of passive and forced drinking harms and intention to drink alcohol after the video-based health talk. In phase two, I conducted a qualitative study and interviewed 20 Hong Kong Chinese university student drinkers to explore their perceptions of using chat-based intervention for alcohol support. In phase three, current university student drinkers with Alcohol Use Disorder Identification Test score ≥ 8 were proactively recruited from 8 universities in Hong Kong to participate in a two-arm, pragmatic, randomized controlled trial. 772 participants were randomized into the intervention or control groups with a 1:1 allocation ratio. Both groups received ASBI at baseline. The intervention group further received chat-based alcohol support guided by behavior change technique for 3 months, and control group received regular text-messaging support on general health with the same duration. The primary outcome was alcohol consumption in gram per week at 6 months follow-up (3 months after treatment) by intention-to-treat. The trial was registered with ClinicalTrials.gov (NCT04025151).

Results: In phase one, secondary school students who attended the video-based health talk with increased knowledge of passive drinking were associated with less intention to drink (adjusted [odds ratio] OR, 0.93; 95% CI, 0.90 to 0.97, P = 0.001), and increased knowledge of health harm (adjusted [unstandardized coefficient] B, 0.06; 95% CI, 0.05 to 0.08, P = 0.001), and social harm of drinking (adjusted B, 0.12; 95% CI, 0.10 to 0.16, P = 0.001). In phase two, interviewees perceived the mobile instant messaging app as a feasible and acceptable platform for chat-based intervention. They preferred to receive messages on personalized problem-solving, drinking harms from credible sources, timely psychosocial support, and goal setting. In phase three, 772 university student drinkers were recruited and randomized into the intervention (n = 385) or control groups (n = 385). The retention rate was 85% at 6 months follow-up. At 6 months, the intervention group had significantly lower alcohol consumption in gram per week (B [gram], -11.42; 95% CI, -19.22 to -3.62; P = 0.004), AUDIT score (B [AUDIT], -1.19; 95% CI, -1.63 to -0.34; P = 0.003), weekly alcohol unit consumption (B [alcohol unit], -1.14; 95% CI, -1.92 to -0.36; P = 0.004), and intention to drink (OR, 0.66; 95% CI, 0.47 to 0.92; P = 0.01).

Conclusions: The quasi-experimental study showed that the video-based health talk was effective in educating them on the harms of alcohol use and reducing their intention to drink. The trial showed that chat-based intervention combined with ASBI was effective in reducing alcohol use in university student drinkers in Hong Kong.