Journal Club

1
Journal Club

• Alcohol, Other Drugs, and Health Current
  Evidence
• JanuaryFebruary 2010

2
Featured Article

• Randomized Controlled Trial
• of Proactive Web-Based Alcohol Screening and
  Brief Intervention
• for University Students
• Kypri K, et al. Arch Intern Med.
  2009169(16)15081514.

3
Study Objective

• To assess the effectiveness of a Web-based
  alcohol screening and brief intervention program
  among college students.

4
Study Design

• Two-arm parallel randomized controlled trial.
• Australian college students age 1724 years
  (N13000) were invited by letter and follow-up
  email to complete the Alcohol Use Disorders
  Identification Test (AUDIT) online.
• Of 7237 respondents, 2435 scored positive for
  hazardous/ harmful drinking (AUDIT score 8) and
  were randomized to either
• 10 minutes of Web-based motivational assessment
  and personalized feedback, or
• screening only.
• Follow-up was at 1 and 6 months. Eighty-four
  percent of participants completed at least 1
  online follow-up assess-ment.

5
Study Design (contd)

• Primary outcome measures were
• frequency of drinking (range, 028 days).
• number of standard drinks per drinking occasion.
• average weekly alcohol consumption.
• Secondary outcome measures were
• prevalence of binge drinking (consuming 4
  standard drinks per drinking occasion for women
  and 6 for men in the last 4 weeks).
• prevalence of heavy drinking (consuming gt14
  standard drinks for women and gt28 for men in the
  last 4 weeks).

6
Assessing Validity of an Article about Therapy

• Are the results valid?
• What are the results?
• How can I apply the results to patient care?

7
Are the Results Valid?

• Were patients randomized?
• Was randomization concealed?
• Were patients analyzed in the groups to which
  they were randomized?
• Were patients in the treatment and control groups
  similar with respect to known prognostic
  variables?

8
Are the Results Valid? (contd)

• Were patients aware of group allocation?
• Were clinicians aware of group allocation?
• Were outcome assessors aware of group allocation?
• Was follow-up complete?

9
Were patients randomized?

• Yes.
• Participants were randomly assigned by Web server
  software to either the control group (screening
  only) or to the intervention group.

10
Was randomization concealed?

• Yes.
• Participants were blind to the true nature of the
  study, which was presented as a series of
  surveys.
• Researchers were blind to group assignments.

11
Were patients analyzed in the groups to which
they were randomized?

• Yes.
• Participants were analyzed in the group to which
  they were randomized (intention to treat).

12
Were the patients in the treatment and control
groups similar?

• Yes.
• Demographic characteristics and reported alcohol
  use were similar between the 2 groups at baseline.

13
Were patients aware of group allocation?

• No.
• Patients were not aware of group allocation.

14
Were clinicians aware of group allocation?

• No.
• Clinicians were not aware of group allocation.

15
Were outcome assessors aware of group allocation?

• No.
• Outcomes were analyzed by computer software.

16
Was follow-up complete?

• No.
• Follow-up data were obtained from 962
  participants in the intervention group (77) and
  942 patients in the control group (80) at 1
  month.
• Follow-up data were obtained from 811
  participants in the intervention group (65) and
  767 participants in the control group (65) at 6
  months.

17
What Are the Results?

• How large was the treatment effect?
• How precise was the estimate of the treatment
  effect?

18
How large was the treatment effect?

• At 1 month, compared with controls, intervention
  participants reported
• lower frequency of drinking (rate ratio RR,
  0.89 95 CI, 0.830.94).
• fewer drinks per occasion (RR, 0.93 95 CI,
  0.880.98).
• lower total alcohol consumption (RR, 0.83 95
  CI, 0.780.90).
• At 6 months, compared with controls, intervention
  participants reported
• lower frequency of drinking (RR, 0.91 95 CI,
  0.850.97).
• no difference in drinks per occasion (RR, 0.96
  95 CI, 0.911.02).
• lower total consumption (RR, 0.89 95 CI,
  0.820.96).

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How large was the treatment effect? (contd)

• Compared with controls, intervention participants
  reported
• large significant reductions in heavy drinking at
  1 month (RR, 0.50 95 CI, 0.35-0.71) and 6
  months (RR, 0.55 95 CI, 0.38-0.80).
• Participants in the intervention group reported
  less binge drinking at both follow-up
  assessments, but the differences were not
  statistically significant.

20
How precise was the estimate of the treatment
effect?

• The confidence intervals were narrow for the
  observed effects.

21
How Can I Apply the Results to Patient Care?

• Were the study patients similar to the patients
  in my practice?
• Were all clinically important outcomes
  considered?
• Are the likely treatment benefits worth the
  potential harm and costs?

22
Were the study patients similar to those in my
practice?

• All patients were Australian undergraduate
  students age 1724.
• Fifty-five percent were men.
• Sixty-five percent lived with a parent or
  guardian.

23
Were all clinically important outcomes considered?

• Yes.
• A variety of cogent drinking outcomes were
• assessed.

24
Are the likely treatment benefits worth the
potential harm and costs?

• Potential harms and costs were not assessed in
  this study.